Ankle brachial index for the diagnosis of lower limb peripheral arterial disease

Abstract

Background Peripheral arterial disease (PAD) of the lower limb is common, with prevalence of both symptomatic and asymptomatic disease estimated at 13% in the over 50 age group. Symptomatic PAD affects about 5% of individuals in Western populations between the ages of 55 and 74 years. The most common initial symptom of PAD is muscle pain on exercise that is relieved by rest and is attributed to reduced lower limb blood flow due to atherosclerotic disease (intermittent claudication). The ankle brachial index (ABI) is widely used by a variety of healthcare professionals, including specialist nurses, physicians, surgeons and podiatrists working in primary and secondary care settings, to assess signs and symptoms of PAD. As the ABI test is non-invasive and inexpensive and is in widespread clinical use, a systematic review of its diagnostic accuracy in people presenting with leg pain suggestive of PAD is highly relevant to routine clinical practice. Objectives To estimate the diagnostic accuracy of the ankle brachial index (ABI)-also known as the ankle brachial pressure index (ABPI)-for the diagnosis of peripheral arterial disease in people who experience leg pain on walking that is alleviated by rest. Search methods We carried out searches of the following databases in August 2013: MEDLINE (Ovid SP),Embase (Ovid SP), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO), Latin American and Caribbean Health Sciences (LILACS) (Bireme),

Contrast-Enhanced Ultrasound Reveals Exercise-Induced Perfusion Deficits in Claudicants

“…The most commonly used noninvasive study, the single-level ankle-to-brachial index, is frequently normal in mild claudicants [18,19]. While exercise ABI is more sensitive, both resting and exercise studies are inherently flawed as they measure the intravascular pressure of named arteries as a surrogate for lower extremity tissue perfusion, which depends on more distal arterial branches and arterioles [27].…”

“…The Ankle-to-Brachial Index (ABI) is a rapid method of detecting lower than normal perfusion pressures [18]. Because the ischemia of claudicants is effort-induced, the resting ABI in these patients is often normal with the addition of provocative exercise, however, the presence of PAD is unmasked, and the exercise ABI in claudicants can be lower than expected [19].…”

Peripheral artery disease

“…Most patients with peripheral artery disease are asymptomatic 120. Claudication is an aching or burning in the muscles of the leg.…”

“…Peripheral artery disease affects around 13% of the Western population who are more than 50 years old 1. It is most commonly due to atherosclerosis, where an atherosclerotic plaque causes arterial stenosis or occlusion.…”

Chronic myeloid leukaemia and tyrosine kinase inhibitor therapy: assessment and management of cardiovascular risk factors

“…The ankle‐brachial index (ABI) is the ratio of the systolic blood pressure in the lower limb to that in the upper limb, and is used as a non‐invasive indicator of significant atherosclerosis. The ABI is reported to have high sensitivity for the detection of significant atherosclerosis in the arteries of the lower limbs in symptomatic patients presenting with claudication . In asymptomatic individuals an abnormal ABI is associated with increased all‐cause mortality (hazard ratio (HR) 2.99; 95% CI 2.16–4.12) and increased CV mortality (HR 2.35; 95% CI 1.91–2.89) .…”