Critical Review of the Ankle Brachial Index

Abstract

Ankle brachial index (ABI) has been utilized in the management of peripheral arterial disease (PAD).ABI is a surrogate marker of atherosclerosis and recent studies indicate its utility as a predictor of future cardiovascular disease and all-cause mortality. Even so, this critical test is underutilized. The purpose of this review is to summarize available evidence associated with ABI methodology variances, ABI usage in the treatment of PAD, and ABI efficacy in predicting cardiovascular disease. This review further evaluates how ABI is used in the prognosis and follow-up of lower extremity arterial disease.We reviewed the most current American College of Cardiology guidelines for the management of PAD, the Trans Atlantic Intersociety Consensus (TASC) working group recommendations, and searched the Medline for the following words: ankle brachial index, ABI sensitivity and specificity, and peripheral arterial disease.The ABI is a simple, noninvasive clinical test that should not only be applied to diagnose PAD, but also to provide important prognostic information about future cardiovascular events. Although the ABI has been employed in clinical practice for some time, our review of various studies reveals a lack of standardization regarding both the method of measuring ABI and the cutoff point for abnormal ABI. It is extremely important that we understand all aspects of this crucial test, as it is now being recommended as part of a patient’s routine health risk assessment.

Association between estimated glomerular filtration rate and peripheral arterial disease

“…For each leg, the higher of the BP values in the dorsalis pedis and posterior tibial arteries was divided by the higher of the left and right arm brachial BP values, and the lower of the two results (right and left leg) was used as ABI in all analyses [19]. The presence of PAD was defined by an ABI 0.9 [3,20].…”

Diabetes and Critical Limb Ischemia: The Deadly Duo in Patients With Symptomatic Peripheral Artery Disease

“…Additionally, lower ABI values correlated with reduced survival and increased rate of concomitant coronary and cerebrovascular disease 38 . Despite a very high incidence of MACE and mortality rate, PAD is still underdiagnosed and undertreated.…”

Peripheral arterial disease and chronic heart failure: a dangerous mix

“…Overall, there has been a lack of attention to PAD despite availability of screening tools and the contribution to adverse health outcomes [11,20,21,[47][48][49]. This emphasises the need for increasing the focus of PAD as an important comorbidity, tailoring multidisciplinary approach to the prevention, treatment and management of PAD and supporting individuals in selfmanagement approaches.…”

“…The authors of the review concluded that the ABI is a simple and convenient tool with high specificity and accuracy for the preliminary diagnosis of PAD in populations aged between 40 and 75 years with at least one vascular risk factor, a profile that is typical of most patients with CHF [20]. Since measurement of the ABI is an effective screening tool in both symptomatic and asymptomatic PAD, standardised screening practices may improve the detection of PAD in patients with CHF [21], thereby allowing targeting and tailoring of chronic disease management interventions.…”