From the Guidelines
Treatment for diminished or absent Dorsalis Pedis pulse with abnormal Doppler signals involves immediate revascularization efforts. Administration of anticoagulant therapy, such as heparin, at a dose of 5000 units intravenously, followed by an infusion of 1000 units per hour, is recommended to prevent further thrombosis 1. Additionally, antiplatelet therapy with aspirin, 325mg orally, and/or clopidogrel, 75mg orally, may be initiated to reduce platelet aggregation and promote blood flow 1.
Key Considerations
- Monitoring of ankle-brachial index (ABI) and pulse volume recordings (PVR) is essential to assess treatment efficacy and guide further management 1.
- The goal of treatment is to restore blood flow to the affected limb and prevent further ischemia 1.
- Treatment options may include catheter-directed thrombolysis, mechanical thrombectomy, or surgical intervention, depending on the severity of the condition and the patient's overall health 1.
Important Factors
- The presence of diminished or absent Dorsalis Pedis pulse with abnormal Doppler signals indicates a high risk of acute limb ischemia (ALI) 1.
- Prompt treatment is essential to prevent irreversible damage and improve outcomes 1.
- A supervised exercise program and initiation of antiplatelet therapy may be recommended to reduce the risk of recurrent ischemia and improve functional status 1.
From the Research
Treatment for Diminished or Absent Dorsalis Pedis Pulse
- The treatment for diminished or absent Dorsalis Pedis pulse with abnormal Doppler signals is not directly stated in the provided studies. However, the studies suggest that patients with absent or diminished pedal pulses are at a higher risk of major vascular outcomes, including peripheral artery disease (PAD), critical limb ischemia, and amputation 2, 3, 4, 5.
- Proximal arterial inflow revascularization (PAIR) has been shown to improve pedal arch quality and wound healing in patients with diabetic foot ulcers 6.
- Branched pedal bypass is a therapeutic option for limb salvage in critical limb ischemia, but its effectiveness compared to simple pedal bypass is still being studied 3.
- The absence of peripheral pulses, including the dorsalis pedis pulse, is a predictor of major macrovascular and microvascular events, death, and cognitive decline in patients with type 2 diabetes 4.
- Patients with absent or diminished pedal pulses should be screened for diabetic kidney disease (DKD) and monitored closely for progression of chronic kidney disease (CKD) 5.
Diagnostic Accuracy and Inter-Rater Agreement
- Pedal pulse palpation has been shown to have good diagnostic accuracy and inter-rater agreement in detecting peripheral artery disease (PAD) 2.
- The presence of a femoral bruit auscultation and a calf circumference <34.55 cm are also diagnostic tests that can be used to detect PAD 2.
Risk Factors and Predictors
- Absent or diminished pedal pulses are independent predictors of major vascular outcomes in patients with type 2 diabetes 4.
- The number of absent peripheral pulses increases the risk of all outcomes, with the highest risks observed in patients with three or four absent pulses 4.
- Urinary endothelin-1 (ET-1) is higher among patients with absent or diminished pedal pulses and is associated with eGFR decline greater than 30% 5.