Ankle-Brachial Index, Toe-Brachial Index, and Pulse Volume Recording in Healthy Young Adults

Abstract

Objective: To clarify the characteristics of ankle-brachial index (ABI), toe-brachial index (TBI), and pulse volume recording (PVR) of the ankle with brachial-ankle pulse wave velocity (baPWV) in healthy young adults. Material and Methods: We analyzed ABI, TBI, baPWV, and PVR in the ankle of healthy adults aged 20 to 25 years (median, 20 years) using an automatic oscillometric device between 2002 and 2013. The ABI, baPWV, and PVR in 1282 legs of 641 subjects (301 men and 340 women) and the TBI in 474 toes of 237 subjects (117 men and 120 women) were evaluated. Results:The measured values showed no bilateral differences. ABI and baPWV were higher in men than in women, but TBI was similar in both sexes. ABI <1.0 was observed in 18.1% of the legs in men and in 25.6% in women. TBI <0.7 was observed in 16.2% of the toes in men and 19.1% in women. For ankle PVR, the % mean arterial pressure was higher in women than in men. The upstroke time was <180 ms in most subjects. Conclusions: For young people, ABI <1.0 or TBI <0.7 may not always indicate vascular abnormalities. When evaluating circulatory indexes, age and sex should be considered.Keywords: ABI, TBI, baPWV, PVR, healthy young adults indications of ABI. The cut-off value of ABI for detecting PAD has been confirmed as 0.9 with high sensitivity and specificity. 2) Moreover, ABI is a strong predictor of cardiovascular events: the normal ABI range was revised as 1.00 to 1.40, because patients with ABI ranging from 0.91 to 0.99 have been shown to be at the borderline of cardiovascular risk. 2) On the other hand, TBI measurements are more cumbersome and are limited to special institutions (e.g., vascular laboratories) using different techniques including laser Doppler flowmetry, photoplethysmography, oscillometric plethysmography, and mercury strain gauge plethysmography. Thus, basic data on a uniform technique for a large population remain limited. Although the cut-off value of TBI for detecting PAD is set at 0.6 or 0.7, there has been no global consensus. 1,[3][4][5] Although the normal standard ranges of ABI and TBI are based on data obtained mostly from middle and senior adults, [3][4][5][6] young patients with lower limb complaints such as coldness, pain, or claudication are also primarily examined by ABI and TBI measurements because PAD including Buerger disease, Raynaud disease, Takayasu arteritis, and even arteriosclerotic diseases can occur in young patients, as the prevalence of PAD is estimated to be 1.2% to 4% of people in their late 20s. 7) However, they occasionally show ABI <1.0 or TBI <0.7 despite their normal physical findings, making the diagnosis confusing.The gold standard method for ABI measurement has been the Doppler method since the 1980s, 2) but on the other hand, automated oscillometric sphygmomanometers have come into use recently. Moreover, full-automated ABI/TBI measuring devices have been developed since the late 1990s. 8,9) We have used the automated ABI/TBI measuring devices in our clinical work. The form PWV/ABI ® (Colin Co., Aichi, Jap...

Use of the ankle-brachial index combined with the percentage of mean arterial pressure at the ankle to improve prediction of all-cause mortality in type 2 diabetes mellitus: An observational study

“…PAD is associated with several atherosclerotic morbidities and is predictive of long-term cardiovascular events [3]. An occluded artery in a lower extremity will result in decreased blood ow, re ected by a decrease in systolic blood pressure and a attened pulse volume waveform at the ankle [16,17]. However, the ankle systolic blood pressure will be elevated in a noncompressible artery, and a false negative PAD diagnosis may occur when ABI alone is used for screening [22,23].…”

Assessment of a low ankle brachial index in young males with congenital hypogonadism

“…Thus, even though these numbers were obtained in middle aged and older adults, false positive PAD diagnosis is not a marginal issue. In a recent study, Watanabe et al studied the characteristics of ossilometric detection of ABI and toe-brachial index along with pulse volume recording of the ankle with brachial-ankle pulse wave velocity in healthy young adult population with the age of 20 to 25 (28). They found the frequency of ABI <1.0 as 18.1% in men and 25.6% in women.…”

Blood Flow Modeling to Improve Cardiovascular Diagnostics: Application of A GTF to Predict Central Aortic Pressure using a 1-D Model

“…Combining equations (7) and (8) yields the wave equation as (9) Using the solution of equation (9) with equations (7) and (8) yields the equation for impedance (analogous to in electrical circuits) (10) where, and while are constants of integration. Inserting the expression for into equation (10) calculated at the input impedance becomes (11) This can be extended to the entire tree by applying the boundary conditions at the small artery bifurcations similar to equations (5) and (6) yields (12) Knowledge of and and the impedances at the terminals of the distance end allows using Equation (11) and (12) to compute the input impedance. Zero impedance is assumed at the distal terminals of the smaller arteries' tree.…”