O índice tornozelo-braquial no diagnóstico da doença arterial periférica e sua relação com outras condições cardiovasculares em pacientes diabéticos: uma revisão integrativa

Abstract

Introduction: Peripheral arterial disease (PAD) is a clinical condition resulting from arterial atherosclerosis, predominantly affecting the lower limbs. Diabetes mellitus is a major risk factor, not only increasing the incidence of the disease but also contributing to its severity and progression. Among diagnostic methods, the ankle-brachial index (ABI) stands out as a simple, low-cost, and widely applicable tool, which is also correlated with the presence of systemic atherosclerosis. However, it is a test with limitations, being influenced by variables such as diabetes, advanced age, and the presence of associated comorbidities. Objective: To assess the efficacy and reliability of the ankle-brachial index in the diagnosis of PAD, as well as its relationship with the development of other cardiovascular diseases in diabetic individuals. Method: This is an integrative literature review based on studies published in the last five years, indexed in the PubMed, Web of Science, LILACS (Latin American and Caribbean Health Sciences Literature), and Cochrane Library databases, with the purpose of gathering the most updated and relevant scientific evidence on the subject. Results: The ABI showed variable but limited sensitivity (35.48%–78%), contrasting with its high specificity (>90%) for the diagnosis of PAD, demonstrating better performance in more severe cases. Furthermore, the index showed a significant association with macro- and microvascular complications such as carotid stenosis, subclinical atherosclerosis, coronary artery disease (CAD), stroke, and retinopathy (p<0.05). The analysis also revealed an association between abnormal ABI and factors such as advanced age, smoking, long-standing diabetes, physical inactivity, dyslipidemia, poor glycemic control, and central obesity, although some findings related to lipid profile and diabetes duration were inconsistent across studies. Conclusion: Despite its limitations, the Ankle-Brachial Index remains clinically relevant in the diagnosis of PAD, especially in advanced cases, and shows a consistent association with systemic atherosclerosis, particularly when interpreted in an individualized manner and integrated with clinical assessment and complementary tests, taking into account the multiple factors that may influence its diagnostic accuracy.