Abnormal Ankle-brachial Pressure Index Research Articles

Prevalence and Prognostic Significance of Asymptomatic Peripheral Arterial Disease in 68-year-old Men with Diabetes. Results from the Population Study ‘Men Born in 1914’ from Malmö, Sweden

Objective To assess the prevalence of asymptomatic peripheral arterial disease (PAD) in older men with diabetes and to compare the incidence of cardiac events and deaths in diabetic and non-diabetic men with abnormal and normal systolic ankle–brachial pressure index, respectively. Research design and methods Population-based cohort of 68-year-old men ( n=474). Diabetes was defined as history of diabetes or a fasting blood glucose ≥6.1 mmol/l. PAD was defined as an ankle–brachial pressure index (ABI) <0.9 in either leg. Fourteen-year mortality and cardiac event rates were based on record linkage with regional and national registers. Results The prevalence of PAD in men with and without diabetes was 29 and 12%, respectively ( p=0.003). The incidence of cardiac events was 22.9/1000 person years in men free from both diabetes and PAD. In the absence of an abnormal pressure index, diabetes was associated with an event rate of 28.4 ( p=0.469). In the presence of an abnormal index the incidence was 102 ( p<0.001). This pattern remained in the multivariate analysis when other atherosclerotic risk factors were taken into account. Cardiovascular mortality rates similarly differed substantially between diabetic men with and without PAD. Conclusions A fasting blood glucose value above 6.1 mmol/l even in the absence of symptoms indicating diabetes was associated by an increased prevalence of asymptomatic PAD. The cardiovascular risk in diabetes varied widely between men with and without abnormal ankle–brachial pressure index.

The effect of the ankle brachial pressure index and the use of a tourniquet upon the outcome of total knee replacement

Current teaching suggests that patients requiring a total knee arthroplasty who have absent pulses or an abnormal ankle-brachial pressure index (ABPI) should be referred for vascular investigation. The aim of this study was to determine whether total knee arthroplasty was safe in such patients. The ABPI was measured with a hand-held Doppler. Patients were excluded if they had active ulceration, rest pain, or an absent femoral pulse, but patients with claudication were included. A total of 73 patients were recruited. Hand-held Doppler detected signals from 98% of arteries. Postoperatively, there were no signs of limb ischemia, and the median ABPIs increased significantly. From our series, it seems safe to proceed with surgery in patients with impalpable foot pulses or claudication, as long as the femoral pulse is palpable and there is no active ulceration or rest pain.

Pulse oximetry in the evaluation of peripheral vascular disease.

The role of pulse oximetry in the evaluation of peripheral vascular disease (PVD) was investigated. In addition, the value of elevating the limb to improve the sensitivity of detection of PVD by the pulse oximeter was also determined. Pulse oximetry reading in the toes were obtained in 40 young, healthy volunteers and in 40 randomly selected patients referred to the vascular investigation laboratory over a period of two months. All 40 healthy volunteers had normal pulse oximetry readings. Normal pulse oximetry reading in the toes was defined as > 95% O2 Sat and +/-2 of finger pulse oximetry reading. In all 40 patients, pulse oximetry readings were either normal or not detected at all. Since there was no gradation in decrease in the pulse oximetry reading with severity of disease or with elevation of the patient's lower extremity, an absent or no reading was considered as an abnormal result from the test. The frequency of abnormal pulse oximetry readings increased significantly in groups with abnormal ankle-brachial pressure index (ABPI) and also varied significantly with elevation of the patients' lower limbs. In patients with no PVD detected by Doppler (ABPI > 0.9), pulse oximetry readings were normal in all. However, in patients with moderate PVD (ABPI, 0.5-0.9), 84% of the patients' lower limbs had normal pulse oximetry readings and 16% had an abnormal reading at baseline level (flat). An additional 12% of the lower limbs in this group had an abnormal reading on elevation of the limb to 12 inches. In patients with severe PVD (ABPI < 0.5), 54% of the patients' lower limbs had an abnormal reading at baseline and an additional 23% had an abnormal reading at elevation of the limb to 12 inches. In conclusion, pulse oximetry was not a sensitive test for detecting early PVD.