Ankle–Brachial Index for Assessment of Peripheral Arterial Disease

Grenon, S. Marlene; Gagnon, Joël; Hsiang, York

doi:10.1056/nejmvcm0807012

Cited by 81 publications

(58 citation statements)

References 7 publications

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“…11 The estimation of the ABI by measuring systolic blood pressure (BP) at the ankle and the arm with a Doppler device is widely used in clinical practice and considered to be the reference method for PAD screening. 12 The current guidelines of the European Society of Hypertension-European Society of Cardiology propose that ABI measurement should be a 'recommended' test in hypertensive patients, with values o0.9 indicating advanced atherosclerosis and increased cardiovascular risk. 13 However, the conventional Doppler ABI measurement is time-consuming and requires specific skills and therefore is not performed as frequently as it should be.…”

Section: Introductionmentioning

confidence: 99%

Automated oscillometric determination of the ankle-brachial index: a systematic review and meta-analysis

2012

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Measurement of the ankle-brachial index (ABI) using a Doppler device is widely used to identify subjects with peripheral artery disease (PAD), and those who are at high risk of cardiovascular disease. This paper presents a systematic review (Medline/ PubMed, Embase and Cochrane) and meta-analysis of studies assessing the usefulness of automated oscillometric devices for ABI estimation and PAD detection compared with the conventional Doppler method. A total of 25 studies including 4186 subjects were analyzed. A random-effects model analysis showed that the average oscillometric ABI was similar to the Doppler ABI (mean difference ± s.e. 0.020 ± 0.018, P ¼ 0.3) but that the absolute differences were significant (0.048 ± 0.009, Po0.01). The pooled correlation coefficient (r) between the oscillometric and Doppler ABI was 0.71 ± 0.05. Simultaneous arm-leg measurements resulted in a smaller difference between the average oscillometric ABI value and the average Doppler ABI value than did sequential measurements ( À0.012 ± 0.022 vs. 0.040 ± 0.026, respectively, Po0.01). The average sensitivity and specificity of the oscillometric ABI estimation in PAD diagnosis was 69 ± 6% and 96 ± 1%, respectively (with Doppler ABI taken as the reference). These data suggest that an automated ABI measurement obtained by oscillometric blood pressure monitors is a reliable and practical alternative to the conventional Doppler measurement for the detection of PAD.To increase the sensitivity of the PAD diagnosis based on an oscillometric ABI, a higher threshold of 1.0 might be preferable.

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Section: Introductionmentioning

confidence: 99%

Automated oscillometric determination of the ankle-brachial index: a systematic review and meta-analysis

2012

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“…Systolic ankle blood pressures of the anterior and posterior tibial artery on both legs were obtained using a hand-held 6-MHz Doppler probe. For each leg, ABI was calculated as the ratio of the highest ankle systolic blood pressure divided by the highest brachial systolic blood pressure, the lower ABI was taken as the study reference [20]. The AOD was defi ned as an ABI of < 0.9 or > 1.3 (incompressible tibial and peroneal arteries due to mediacalcinosis) according to the ESH/ESC guidelines for the management of arterial hypertension [9].…”

Section: Ankle-brachial Index Peripheral and Central Pulse Pressurementioning

confidence: 99%

Sensitivities of in vivo markers of arterial organ damage in patients with peripheral atherosclerosis

Frick

Baumann

Sick³

et al. 2018

Vasa

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Summary:Background: Biomarkers of vascular diseases such as ankle-brachial index (ABI), peripheral pulse pressure (pPP), central pulse pressure (cPP), and pulse wave velocity (PWV) allow assessment of arterial organ damage (AOD). However, the utility of markers other than ABI in patients with peripheral arterial disease (PAD), which are also associated with a significant increase of cardiovascular events, remains unclear. Patients and methods: Asymptomatic (n = 21) and symptomatic patients (n = 46) with a positive sonography for PAD or history of lower limb revascularization were included. ABI, pPP, cPP, and PWV were assessed. PWV were performed using a brachial cuff-based method (aortic PWV (aPWV)) and oscillography (carotid-femoral pulse wave velocity (cfPWV)), respectively. The two methods for PWV were compared using Bland Altman analysis. Sensitivities of ABI, pPP, cPP, cfPWV, and aPWV for AOD were calculated. Results: Sixty-seven patients (35.8 % female, mean age 69, range 39-91 years) had a signifi cantly higher aPWV than cfPWV (median 10.5 m/s (IQR: 8.8-12.65 m/s) vs. median 9.0 m/s (IQR: 7.57-10.55 m/s), p = 0.0013). There was no correlation between cfPWV and age (r = 0.311, p = 0.116). Bland Altman analysis revealed a mean difference of -1.04 (-2SD; -6.38 to + 2SD; 4.31). The sensitivities for AOD were 68.7 % for ABI, 61.2 % for aPWV, 40.3 % for cfPWV, 31.3 % for peripheral PP, and 10.4 % for central aortic PP (p < 0.001). Conclusions: Brachial-derived aPWV differs from the gold standard assessment (cfPWV), which may be underestimated in PAD due to atherosclerotic obstructions along the aorto-iliac segment. The sensitivities of noninvasive in vivo markers of AOD vary widely and tend to underestimate the actual presence of AOD.

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“…Critical-limb ischemia is a particularly severe form of PAD, and once patients have progressed to that level, the morbidity, mortality and economic burden are even more considerable 4 5. The ankle-brachial index (ABI) is a simple, noninvasive test that can be done in the practitioner's office to identify patients with PAD 6. At the present time, it is recommended that patients with PAD be treated with antiplatelet and lipid-lowering agents, along with management of their hypertension, hyperglycemia and lifestyle modifications7 in order to reduce the risk of cardiovascular complications.…”

Section: Peripheral Arterial Disease: the Beastmentioning

confidence: 99%

Aspirin prophylaxis (100 mg daily) does not improve cardiovascular outcomes compared to placebo in asymptomatic individuals with incidental low-ankle brachial index

Grenon

Conte²

2010

Evid Based Med

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Ankle–Brachial Index for Assessment of Peripheral Arterial Disease

Cited by 81 publications

References 7 publications

Automated oscillometric determination of the ankle-brachial index: a systematic review and meta-analysis

Automated oscillometric determination of the ankle-brachial index: a systematic review and meta-analysis

Sensitivities of in vivo markers of arterial organ damage in patients with peripheral atherosclerosis

Aspirin prophylaxis (100 mg daily) does not improve cardiovascular outcomes compared to placebo in asymptomatic individuals with incidental low-ankle brachial index

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