It is vital to have an idea of PAD and to understand that this is related to increased cardiovascular morbidity and mortality. It is very much needed for those with comorbidities which are known to cause atherosclerotic vascular diseases. In regular practice, ABI testing is not carried out routinely. ABI - the technical aspects of daily practice
All clinics should have Doppler instruments, and all clinicians should be trained on how to use this device. The most common reason for not checking the ABI is the lack of practice of using Doppler ultrasound for better and accurate measurement of both brachial and ankle systolic pressures. This will not only detect PAD but also add quality of life to the patients with the institution of therapeutic measures. In high-risk patients such as smokers, hypertensives and diabetics, determination of ABI should be routine practice by primary healthcare professionals. An ABI of 0.9 or lower is indicative of PAD. This is very helpful in screening for PAD of the lower extremities. Both sensitivity and specificity improve dramatically with the help of the most useful non-invasive test – the ABI.
Hence, depending on this symptom of the peripheral occlusive vascular disease is of low sensitivity. It is crucial to know that “intermittent claudication” does not reliably indicate the presence of PAD/LEAD. Here lies the enormous importance of promoting the use of the ABI in regular clinical practice for early detection. However, the prevalence in individuals with diabetes ranges from 20% to 30%. Prevalence and epidemiologyĪmong individuals aged 40 years and older, the prevalence of LEAD is 4.3%, ranging from 3.1% to 5.5%. This applies to both symptomatic as well as asymptomatic PAD/LEAD patients.Īlthough the diagnostic accuracy of computed tomography (CT) angiography is the gold standard for the detection of PAD, adding other diagnostic tools after ABI such as treadmill tests, ultrasound imaging, MRI imaging and digital subtraction angiography, is also invaluable for detecting PAD/LEAD.
The determination of an ABI of less than 0.9 is a reliable indicator of the presence of lower extremity PAD, indicating athero-occlusive arterial disease. These are all (either singly or in combination) significant risk factors for PAD/LEAD. The percentage of the population affected by PAD/LEAD is very significant however, a lot of apathy still remains on the part of clinicians to determine ABI routinely, particularly in patients with the modifiable risk factors of tobacco smoking, hypertension, diabetes and dyslipidaemia. In this article, the discussions for all practical purposes will be on “lower extremity artery disease” (LEAD).Īn ABI value of 1.1 to 1.4 is good evidence of normal arterial flow.
This is the easiest way to detect the presence or absence of atherosclerotic peripheral arterial disease (PAD). The measurement is non-invasive and simple.
The normal range of ABI lies between 0.9 and 1.4. The blood pressure measurement is taken after the patient has been at rest in the supine position for about 10 minutes. The ankle-brachial index (ABI) is the ratio of the systolic blood pressure at the ankle divided by systolic pressure at the upper arm. Ankle brachial index (ABI), lower extremity artery disease (LEAD), peripheral artery disease (PAD) Introduction