Date:

To

The Registrar,

KNR University of Health Sciences,

Warangal.

Respected Sir,

Sub - PG Dissertation Title registration with KNR UHS, Warangal.

I am Dr. VUNNAM PRADEEP KUMAR doing my Post Graduation (MS) in General

Surgery (2021 -2022 Batch) Mamata Medical College, Khammam.

I am doing my dissertation under the guidance of Dr. (Col) PRASAN KUMAR HOTA
M.S. Professor and HOD, in the Department of General Surgery.

I am here with submitting the Dissertation title and Abstract for registration with KNR
UHS, Warangal.

Hence, I request you to grant permission to do the above dissertation work.

Thanking You,

Yours sincerely,

Dr. VUNNAM PRADEEP KUMAR

 Registration of Dissertation Topic

Name of the student : DR. VUNNAM PRADEEP KUMAR

PG Degree course in the subject : GENERAL SURGERY

Name of the Medical College : MAMATA MEDICAL COLLEGE

Title of the topic : A COMPARATIVE STUDY ON DUPLEX SCAN

VS ANKLE BRACHIAL PRESSURE INDEX

MEASUREMENTS FOR DETECTION OF

PERIPHERAL VASCULAR DISEASE IN

DIABETIC FOOT ULCER.

Name of the Guide : Dr. (Col) PRASAN KUMAR HOTA M.S.

Date of joining the course : 11/04/2022

Date of commencement of course : 01/02/2022

Date of presentation or submission: 20/07/2022

Sl. No. Points to be considered (Guidelines)

1. Interest shown in selecting a topic
2. Appropriate review of literature
3. Discussion with guide and other faculty
4. Quality of protocol
5. Preparation of proforma

Sl. No. Name of the faculty and designation Average grade

Signatures of Dissertation Committee

Signatures of Candidate

Signature of Guide

Signature of the HOD with office seal Signature of the Principal with office seal
A COMPARATIVE STUDY ON DUPLEX SCAN VS ANKLE BRACHIAL
PRESSURE INDEX MEASUREMENTS FOR DETECTION OF
PERIPHERAL VASCULAR DISEASE IN DIABETIC FOOT ULCER

DISSERTATION TOPIC TO

KNR University of Health Sciences, Warangal

By

Dr. VUNNAM PRADEEP KUMAR, M.B.B.S.

Under the guidance of

Dr. (Col) PRASAN KUMAR HOTA, M.S.,

Professor and HOD, Department of General Surgery

Mamata Medical College & General Hospital, Khammam.

 ABSTRACT

TITLE OF DISSERTATION: A COMPARATIVE STUDY ON DUPLEX SCAN VS

ANKLE BRACHIAL PRESSURE INDEX MEASUREMENTS FOR DETECTION OF
PERIPHERAL VASCULAR DISEASE IN DIABETIC FOOT ULCER

INTRODUCTION:

Diabetes usually ends with complications like retinopathy, neuropathy, nephropathy,

cardiovascular and peripheral vascular diseases and infections. 1 The major risk factors
leading to diabetic foot ulcer is neuropathic and vascular changes due to poor diabetic
control.2 Peripheral vascular disease (PVD) is a manifestation of atherosclerosis in the
peripheral arteries, resulting in reduced lower limb tissue perfusion leading to clinical
manifestations like claudication, gangrene and subsequent loss of the affected limb.3
Currently, foot problems are an important cause of morbidity in diabetes. Diabetic Foot
Ulcer (DFU) precedes the majority of amputation in diabetics. Diabetes accounts for
up to 50% of non-traumatic leg amputations and 1% of diabetic people have
undergone amputation.1
There are many traditional non-invasive tests available to assess PVD such as Ankle
Brachial Pressure Index (ABPI), Toe-Brachial Index, Segmental Pressure
Examination and pulse volume recordings. Colour duplex scan, magnetic resonance
angiography (MR angiography), and computed tomographic angiography (CT
angiography) are new techniques available to diagnose PVD. However, these new
methods are time consuming, expensive and not easily accessible in low resource
countries.4
The ABPI is defined as the ratio of the ankle systolic blood pressure of affected limb
to highest brachial systolic blood pressure. 5 The ABPI is an easily applicable, less
expensive, non-invasive test that can be used as the standard for the diagnosis of
lower extremity PVD in field surveys, vascular laboratories and clinic practice. ABPI is
mostly used in primary health care setting for the early detection and cost-effective
treatment of PVD.5
Arterial duplex ultrasonographic examination of the lower extremities can be used to
diagnose PVD. It is helpful in determining the exact location of disease and in
differentiating between stenotic and occlusive lesion, an added benefit when preparing
for an intervention.1
Hence it is proposed to conduct a study to evaluate the accuracy of ankle brachial
pressure index and Duplex scan in detection of peripheral vascular disease in diabetic
foot ulcer.

AIMS AND OBJECTIVES:

 To determine the accuracy of Ankle Brachial Pressure Index calculated by hand

held doppler compared to Duplex scan in peripheral vascular disease
associated with diabetic foot ulcer.
 To compare the sensitivity and specificity of Ankle Brachial Pressure Index with
duplex scan for the diagnosis of Peripheral vascular disease in patients with
diabetic foot ulcer.
 To assess the utility of Ankle Brachial Pressure Index as a screening test for
peripheral vascular disease in diabetic foot ulcer cases.

MATERIALS AND METHODS:

 STUDY DESIGN : Prospective comparative study.

 STUDY PERIOD : August 2022 to July 2024.
 STUDY PLACE : Department of General Surgery,
Mamata General Hospital, Khammam.
 SAMPLE SIZE : Minimum of 30 patients.

METHOD OF COLLECTION OF DATA:

This study will comprise a minimum of 30 patients with history of diabetic foot ulcers
admitted in the surgical wards of Mamata General Hospital with following inclusion
and exclusion criteria.

 Informed written consent will be taken from the patients after full explanation of
the study.
 Ethical committee clearance will be taken prior to the study.

INCLUSION CRITERIA:

 All the patients who are admitted in the wards with diabetic foot ulcers.
 Patients above 18 years of age irrespective of sex.
 People willing to participate in the study.
EXCLUSION CRITERIA:

 Patients with rest pain.

 Patients below 18 years of age.
 Patients with clinically evident other causes of peripheral neuropathy.
 Patients with signs suggestive of critical lower limb ischemia.
 Patients not willing to participate in the study.

METHODOLOGY:

 Clinically suspected cases of Peripheral vascular disease with diabetic foot

ulcers admitted in the surgical wards of Mamata General Hospital, will be
included in the study after obtaining the consent for the same.
 A detailed clinical history will be taken followed by general physical examination
with detailed local and systemic examination will be carried out.
 Patients will then be subjected to routine blood examination Includes fasting
blood sugar, HbA1c and other relevant blood investigations. Wound culture and
sensitivity test from the ulcer discharge will be done in every case.
 Antibiotics will be given according to the wound culture and sensitivity report.
Debridement and daily dressings will be done.
 ABPI will be calculated using hand held doppler.
 Duplex scan will be done for both the lower limbs.
 All the findings will be recorded for each patient as per the proforma.

STATISTICAL ANALYSIS:

 The outcomes will be recorded and analysed at the end of the study using
statistical package for social sciences (SPSS).

REFERENCES:

1. Agarwal S, Mehta R, Joshi CP. Comparison of colour Doppler ultrasound and

ankle-brachial pressure index measurements in peripheral vascular disease in

type 2 diabetic patients with foot infections. Int Surg J. 2016 May;3(2): 537-542.

doi:10.18203/2349-2902.isj20160953.
 2. Khan Y, Khan MM, Jain A, Namdev RK. A study of association of Diabetic

Foot Ulcers and Peripheral Vascular Disease. Int J Adv Med. 2018

Dec;5(6):1454-1459. doi: 10.18203/2349-3933.ijam20184756.

3. Kyle D, Boylan L, Wilson L, Haining S, Oates C, Sims A, Guri I, Allen J, Wilkes

S, Stansby G. Accuracy of Peripheral Arterial Disease Registers in UK General

Practice: Case-Control Study. J Prim Care Community Health. 2020 Jan-

Dec;11: 2150132720946148. doi: 10.1177/2150132720946148. PMID:

32959726; PMCID: PMC7513392.

4. Gamal El Dein AI, Ebeed AE, Ahmed HM, Ahmed Abdel Khalek Abdel Razek.

Comparative study between duplex ultrasound and 160-multidetectors CT

angiography in assessment of chronic lower limb ischemia. Egypt J Radiol Nucl

Med.2019; 50,10. doi: 10.1186/s43055-019-0010-2.

5. Weragoda J, Seneviratne R, Weerasinghe MC, Wijeyaratne SM. ABPI against

Colour Duplex Scan: A Screening Tool for Detection of Peripheral Arterial

Disease in Low Resource Setting Approach to Validation. Int J Vasc Med.

2016; 1390475. doi:10.1155/2016/1390475. PMID: 27034837;

PMCID: PMC4806287.

Name of the student: Name of the Guide:

Dr. Vunnam Pradeep Kumar Dr. (Col) Prasan Kumar Hota M.S.

Speciality: General Surgery Professor and HOD

Department of General Surgery

Signature: Signature: