Use and Utility of Ankle Brachial Index in Patients with Diabetes

Abstract

Ankle brachial index (ABI) is a simple method to screen peripheral arterial disease (PAD) and to evaluate cardiovascular (CV) prognosis in the general population. Measuring it requires a hand-held Doppler probe but it can be done also with an automatic device. ABI is an effective tool for clinical practice or clinical studies. However, in diabetic patients, it has some specific caveats. Sensitivity of the standard threshold of 0.9 appears to be lower in diabetic patients with complications. Moreover, highly frequent arterial medial calcifications in diabetes increase ABI. It has been demonstrated that measurements >1.3 are well correlated with both an increased prevalence of PAD and CV risk. Therefore, ABI thresholds of less than 0.9 and more than 1.3 are highly suspicious for PAD and high CV risk in diabetic patients. However, when there is concomitant clinical peripheral neuropathy or high risk of arterial calcification, the efficiency of ABI seems to be limited. In this case, other methods should be applied, toe pressure, in particular. Thus, the ABI could be used in patients with diabetes, but values should be interpreted with precision, according to the clinical situation.

Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link?

“…It has long been known that the sensitivity of the ABI to correctly diagnose PAD is considerably reduced in the presence of arterial media calcification and that, clinically, this calcification is associated with the presence of peripheral neuropathy [38,39] . Accordingly, in the presence of peripheral neuropathy it is recommended to use an alternative method, such as flow wave analysis using Doppler colour ultrasound [40,41] . In our experience this limitation is not negligible.…”

BclI glucocorticoid receptor polymorphism in relation to cardiovascular variables: the Hoorn and CODAM studies

“…Since participants suffering from acute inflammation could complicate the results (30, 37), we repeated the analyses after excluding participants with possible acute inflammation (CRP O10 mg/l, nZ145). Furthermore, we adjusted the SBP and MAP analyses for use of antihypertensive medication (yes/no) and we repeated the ABI analyses after excluding participants with an ABI above 1.3 (nZ45), since this is sometimes proposed as a cut-off point for a normal ABI (27,38).…”

Ankle-brachial index and diabetic neuropathy: study of 225 patients

“…The International Working Group on the Diabetic Foot Guidelines suggests that, added to the symptoms of neuropathic pain, vascular insufficiency can be evaluated by a manual Doppler and calculated by an ABI of less than 0.9, to assess for possible revascularization. This peripheral arterial involvement is diffuse and particularly severe in the tibial arteries with a high prevalence of occlusion 13,17,18,19 . We believe that this study is of real importance, since through the application of a simple examination, the ABI, along with an examination for neuropathic pain and the DN4 questionnaire, further evidence of the relationship between arterial damage and the presence of neuropathy in diabetics can be found.…”

“…It is recommended that the ABI is performed on all patients older than 50 years of age or any patient with symptoms of pain when walking 2,13,15 . Many individuals with diabetes have few symptoms because, despite extensive loss of vascularized tissue, sensation loss is common due to the distal sensory polyneuropathy.…”

“…The ABI is used to diagnose peripheral arterial disease, as well as to estimate future progression and severity 13 .…”