Oscillometric measurement of the ankle-brachial index

Abstract

Peripheral arterial disease is a coronary risk equivalent; a low ankle-brachial index (ABI) is indicative of systemic vascular disease, and should place a patient in the high-risk category. Few physicians measure ABI because it is technically challenging and time consuming. Oscillometric blood pressure monitors are readily available and easy to use. The use of a simple method of documenting ABI was assessed and compared with the conventional method. The oscillometric ABI (OABI) was measured for normal volunteers, patients attending a cardiovascular risk clinic (Cardiovascular Risk Factor Reduction Unit [CRFRU] at the University of Saskatchewan, Saskatoon) and patients referred to a vascular laboratory (vasc lab). The latter group had Doppler ABI (DABI) measurements and served to validate OABI. An Omron HEM 711C oscillometric system (Omron Canada Inc) with appropriate cuff size for arm and leg circumference was used. The mean +/- SEM OABI was 1.13+/-0.08 in normal volunteers (n=26), 1.10+/-0.10 in CRFRU patients (n=11, P not significant) and 1.03+/-0.14 in vasc lab patients (n=57, P<0.05 compared with normal volunteers). No difference was found between sexes, and there was no correlation with age. In the vasc lab group, the correlation with DABI was 0.71 (P<0.05). The sensitivity of OABI to detect DABI of less than 0.9 was 0.71, and the specificity was 0.89. OABI was found to be less sensitive at detecting low values in patients with nonpalpable pulses on physical examination. The OABI is feasible and operator-independent, but does not detect low ABI efficiently. If OABI is abnormal, low DABI is likely. The OABI is less likely to detect disease in patients with nonpalpable peripheral pulses. Such patients are better referred directly to a vascular laboratory for DABI testing.