Ankle-Brachial Index – Areas of use by medical field
Ankle-Brachial Index measurement is often overlooked, despite it being one of the most important measurements from primary care onwards. Read more about the specifics of Ankle-Brachial Index measurement in different fields of healthcare and why timely measurement is so important.
Measurements of the Ankle-Brachial Index (ABI) contribute to correct indications for surgical therapy and are mandatory in the follow up of patients after surgical treatment.
Asymptomatic low ABI has a prognostic value to predict perioperative myocardial damage in vascular surgery patients, incremental to risk factors imbedded in conventional cardiac risk indices.
Goodney PP, Tarulli M, Faerber AE, Schanzer A, Zwolak RM. Fifteen-year trends in lower limb amputation, revascularization, and preventive measures among Medicare patients. JAMA Surg. 2015;150(1):84-86.
W.-J. Flu, J.-P. van Kuijk, M.T. Vouˆte, R. Kuiper, H.J.M. Verhagen, J.J. Bax, D. Poldermans. Asymptomatic Low Ankle-Brachial Index in Vascular Surgery Patients: A Predictor of Perioperative Myocardial Damage. European Journal of Vascular & Endovascular Srugery, 2010
There is a clear need for spreading the awareness of the importance of early diagnosis and guideline-directed therapy of PAD, which may promote more timely initiation and optimized secondary prevention strategies to mitigate risk for adverse limb outcomes.
Primary care physicians are in a pivotal position within the healthcare system to improve the standard of care for patients with PAD. This improvement can be achieved if physicians follow the guidelines and perform an Ankle-Brachial Index measurement on all patients in the cardiovascular risk group, regardless of presenting symptoms.
Association of Ankle-Brachial Indices With Limb Revascularization or Amputation in Patients With Peripheral Artery Disease Homam Moussa Pacha, MD1; Vishnu P. Mallipeddi, MBBS1; Naveed Afzal, PhD2; et al, October 17, 2018.
- Diehm, H. Darius, et al, Prognostic value of a low post-exercise Ankle-Brachial Index as assessed by primary care physicians, Atherosclerosis 2011
- van Langen, J. van Grup, et al, Interobserver variability of Ankle–Brachial Index measurements at rest and post exercisein patients with intermittent claudication, Vascular Medicine, 2009
According to new 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS), “it is the outmost importance that every cardiologist should be sensitive to the diagnosis and management of patients with PADs,…”
The Ankle-Brachial Index (ABI) is a simple, non-invasive, and inexpensive method used in the diagnosis of peripheral arterial disease (PAD) and can identify individuals at risk for cardiovascular disease in other arteries of the body, especially the coronary and carotid arteries.
De Oliveira, Dinaldo Cavalcanti et al., Association Between Ankle-Brachial Index and Coronary Lesions Assessed by Coronary Angiography. Cardiology research vol. 6,1 (2015): 216-220. doi:10.14740/cr376w
Dermatology, Compression therapy and Wound care management
Ankle-Brachial Index is a crucial measurement in wound care management and in compression therapy.
ABI measurement should be performed to:
- Determine adequate arterial blood flow prior to compression therapy
- Rule out PAD/LEAD with a lower extremity wound
- Assess wound healing potential
- Evaluate therapeutic outcome
- Determine safe level of compression
Compression for Primary Prevention, Treatment, and Prevention of Recurrence of Venous Leg Ulcers: An Evidence-and Consensus-Based Algorithm for Care Across the Continuum, Journal of Wound Ostomy & Continence Nursing, 2016
Kidney disease is an independent risk factor for the development of PAD and several studies have implicated poor renal function as a factor in increasing cardiovascular events and mortality. According to KDOQI guidelines, all patients should be evaluated for PAD at the time of dialysis. Among CKD patients, those with low ABI have a higher rate of cardiovascular events and mortality and the disease in those patients progresses faster than in patients without kidney disease.
Meng-Chuan Liu, Yen-Wei Lee, Po-Tseng Lee et al, Ankle-Brachial Index Is a Powerful Predictor of Renal Outcome and Cardiovascular Events in Patients with Chronic Kidney Disease, Scientific World Journal. 2012; 2012: 238494. Published online 2012, Jan 4th
Ankle-Brachial Index (ABI) is used as a screening tool to determine the possible presence of Peripheral Arterial Disease (PAD) and therefore indicate further management. It is especially useful in the post-operative care of revascularized patients.
Although PAD is very common in patients with diabetes, it is grossly under-recognized in this type of population. Diagnosis is often difficult when diabetes is associated with peripheral neuropathy (a condition that causes numbness in the feet), because this condition could mask the pain and lead to a big prevalence of wounds, ulcers and amputations in diabetic patients.
Diabetes increases the risk of lower extremity Peripheral-Arterial Disease by 2- to 4-fold and is present in 12% to 20% of persons with lower extremity PAD, so Ankle-Brachial Index should always be the first measurement in diabetic patients, followed by a TBI measurement.
- Jin, J. Ma, Y. Shen, An Analysis of the Relationship Between Ankle–Brachial Index and Estimated Glomerular Filtration Rate in Type 2 Diabetes
Measurements of the Ankle-Brachial Index are essential in the differential diagnosis of lower extremity pain. In addition, a recurrent ischemia associated with PAD may cause muscle denervation, which may be one of the mechanisms responsible for decreased exercise performance in these patients.
- D. England, J. G. Regensteiner, S. P. Ringel, M. R. Carry, W. R. Hiatt, Muscle denervation in Peripheral Arterial Disease, Neurology, 1992