Ankle-brachial Index In Patients Research Articles

The characteristics of arterial risk factors and ankle-brachial index in patients with lower extremity chronic venous diseases: results from the BEST study.

The aim of our study was to explore the characteristics of the arterial risk factors and ankle-brachial index (ABI) in patients with lower extremity chronic venous disease (LECVD). A total of 2642 subjects were employed in our study. The lifestyle and clinical data were collected. The history of vascular diseases contained coronary artery disease, stroke, hypertension, and diabetes. ABI low than 0.9 was considered as lower extremity artery disease (LEAD). A series of blood indicators were measured. Patients with ABI low than 0.9 belonged to the group of LEAD. Age, smoking, drinking, hypertension, diabetes mellitus, lipid-lowering drug, antidiabetic, total protein, total protein, triglyceride, low-density lipoprotein cholesterol, glycosylated hemoglobin and homocysteine were the common risk factors shared by LEAD and LECVD (P<0.05). The prevalence of LEAD in patients with LECVD was higher than those without LECVD (P<0.05). In Pearson correlation analysis, LECVD was related to LEAD (P<0.05). Before and after adjusted shared factors, as the performance of the logistic regression models, LEAD was an independent risk factor for the prevalence of LECVD (OR=2.937, 95% CI: [1.956, 4.411], P<0.001). Our study demonstrated that an ABI lower than 0.9 is an independent risk factor for LECVD.

Peculiarities of polyvascular disease and the diagnostic significance of the ankle-brachial index in patients with coronary artery disease: results from the real-world registry KAMMA (Clinical registry on patient population with polyvascular disease in the Russian Federation and Eurasian countries)

Aim. To investigate the prevalence and characteristics of polyvascular disease in the Eurasian region's population with one or more previously established locations of atherosclerotic arterial damage, and to evaluate the diagnostic importance of the ankle-brachial index (ABI) as a marker for polyvascular disease (PVD).Material and methods. A total of 1837 patients were included in the main branch of the KAMMA registry (patients with PVD), among which 91,6% had coronary artery disease (CAD) (n=1683). For further analysis, the group of patients with CAD was combined with 1222 patients included in the second branch of the registry — KAMMA-cardio, forming a patient population (n=2905), in which all patients had verified CAD. The mean age of patients was 66,0 [59,0; 72,0] years, with 60,3% being male. Peripheral arteries was assessed using ultrasound examination.Results. PVD was present in 95,6% of patients with coronary atherosclerosis: dual-region involvement was observed in 51,3% of patients, three-region involvement in 37,1%, four-region involvement in 3,4%, and five-region involvement in 2,0%. Stenoses of the common carotid artery were observed in 71% of patients, internal carotid artery — in 68%, lower limb artery — in 52%, and renal and mesenteric artery — in 8,3%. There were following diagnostic effectiveness of the ABI for detecting patients with lower limb artery stenosis was: sensitivity — 58,0%, specificity — 83,6%. The quality of antithrombotic and lipid-lowering therapy was insufficient.Conclusion. In the overwhelming majority (95,6%) of patients with CAD in the KAMMA registry, PVD was revealed, with nearly half of the patients having involvement in three or more arterial zones. In the patient population with CAD, there should be an active effort to identify patients with PVD, using at least the ABI determination and active modern antithrombotic and lipid-lowering therapy according to current clinical guidelines.

Показатели суточного мониторинга артериального давления у лиц старческого возраста c хронической сердечной недостаточностью в зависимости от жесткости сосудов

INTRODUCTION: Measurement of arterial pressure (AP) is a standard method for assessing the risk of developing cardiovascular diseases. Analysis of systolic and diastolic pressure, as well as their ratio, can help determine the risk of developing cardiovascular diseases. One of the ways to diagnose elevatedarterial pressure is daily monitoring of arterial pressure (DMAP). An increase in AP in the elderly is usually associated with an increase in the stiffness of the vascular walls. This leads to an increase in systolic arterial pressure (SAP) and pulse pressure (PP), as well as a decrease in diastolic arterial pressure (DAP). Elevated arterial pressure enhances the load on the heart and can lead to its pathological alterations. A decrease in DAP impairs the blood supply to the heart, which can cause ischemia and fibrosis; the result isdevelopment of diastolic dysfunction, which is the main cause of chronic heart failure (CHF). Currently, a promising way to determine the arterial stiffness is measurement of a cardio-ankle vascular index.The prognostic and diagnostic value of this parameter has been confirmed by numerous studies. It is important to study the parameters of the daily AP profile and arterial stiffness in older patients with CHF. This permits to identify malignant forms of elevated blood pressure, which can lead to cardiovascular complications. AIM: To study the characteristics of the parameters of the daily arterial pressure profile in elderly patients with CHF, depending on the vascular stiffness determined by volume sphygmography. MATERIALS AND METHODS: One hundred and twenty elderly patients with CHF undergoing treatment in a cardiology hospital were examined. By the method of volume sphygmography, the patients were divided into groups with ‘vessels of normal stiffness’ (group 1) and ‘stiff vessels’ (group 2), with subsequentDMAP. A statistical analysis of the parameters of the daily AP profile in the groups was performed. RESULTS: In patients of group 1, both daytime and nighttime SAP, DAP and PP, were significantly higher than in patients of group 2. Besides, in group 1, there was a nighttime decrease in SAP and DAP, while the morning rise of SAP was statistically higher in group 2, and no differences were recorded between the groups in the morning rise of DAP. When assessing the ankle-brachial index in patients of group 2, daytime and nighttime SAP and DAP were statistically higher. In group 1 (with probable peripheral atherosclerosis), PP was higher both during the day and at night. The nocturnal decrease in SAP was statistically higher in group 2, while the nocturnal decrease in DAP prevailed in group 1. The morning rise of SAP and DAP was higher in group 1. CONCLUSION: The DMAP data may indicate to some extent the severity of hypertension in patients with CHF, and this probably depends on the ‘stiffness of the vessels’. In elderly patients with CHF with ‘normal stiffness’ of vessels, the parameters of the daily arterial pressure profile were higher than in patients with ‘stiff vessels’. However, the daily range of parameters of the daily arterial pressure profile was greater in the group of patients with ‘stiff vessels’ (group 2).

The Accuracy and Reliability of Automated Oscillometric Measurement of Ankle-Brachial Index in the Diagnosis of Peripheral Artery Disease

Comparing the accuracy and reliability of ankle-brachial index (ABI) measured by an oscillometric device with the Doppler method in peripheral arterial disease (PAD). 122 patients admitted to the department of interventional radiology with PAD were studied. ABI was measured with the 2 methods in random order. After excluding the inconclusive results, Doppler ABIs were compared with the oscillometric ABIs in each limb, the reliability was evaluated by intraclass correlation coefficient (ICC), and the accuracy and consistency were assessed by receiver operating characteristic curves and Bland-Altman method. In 122 patients (244 legs), 27 legs got inconclusive oscillometric results, 4 legs got inconclusive oscillometric and inconclusive dorsalis pedis artery Doppler results, 2 legs had oscillometric cuff pressure intolerance. Using Doppler ABI <0.9 as a diagnostic threshold, compared with the high Doppler ABI, oscillometric method had a sensitivity of 57.81%, a specificity of 95.18%, the ICC was 0.626 (95% confidence interval [CI]: 0.536-0.701), Bland-Altman method showed 11/211 (5.21%) difference points outside the 95% limits of agreement. Compared with the low Doppler ABI, oscillometric method had a sensitivity of 50.66%, a specificity of 98.31%, the ICC was 0.541(95% CI: 0.483-0.630), Bland-Altman method showed 11/211 (5.21%) difference points outside the 95% limits of agreement. Using 1.00 as the diagnostic threshold and considering error oscillometric results as abnormal ABIs, the sensitivity improved to 88.05% with high Doppler ABI and 81.42% with the low. The accuracy and reliability of oscillometric ABI in patients with PAD is unsatisfied, which makes it not suitable as an alternative method in clinic disease assessment. Using 1.0 as the ABI oscillometric threshold for PAD diagnosis can improve the diagnostic value.

Open Bypass Is Superior to Endovascular Revascularization in Patients Undergoing Reintervention for Chronic Limb-threatening Ischemia Using a Medicare-linked Database

The need for reinterventions following lower extremity revascularization (LER) is common, ranging from 13% to 85% depending on different follow-up periods. Prior literature has detailed the outcomes of bypass therapy (BT) and endovascular therapy (ET) for initial LER for chronic limb-threatening ischemia. Nonetheless, there is a paucity of data regarding the best revascularization technique for patients undergoing reintervention following prior revascularization. This study aims to describe the outcomes of BT vs ET in patients with prior open or endovascular LER. We identified all patients with a history of prior ipsilateral LER who had undergone redo LER for chronic limb-threatening ischemia from 2010 to 2019 in the Vascular Quality Initiative VISION database. Patients who had undergone suprainguinal procedures were excluded. Study groups included BT vs ET in patients with prior ET and BT vs ET in patients with prior BT. A total of 17,145 patients had undergone prior ET with 69.7% undergoing redo ET and 30.3% undergoing BT, and 15,905 patients had undergone prior BT with 83.7% undergoing ET and 16.3% undergoing redo BT. Among patients with prior ET, patients undergoing BT were more likely to be smokers (79% vs 67.1%; P < .001), present with rest pain (38.8% vs 27%; P < .001), and lower ankle-brachial index (ABI) (0.6 ± 0.6 vs 0.8 ± 0.6; P < .001). BT was associated with a lower risk of 1-year major amputation/death (adjusted hazard ratio [aHR], 0.75; 95% confidence interval [CI], 0.7-0.8; P < .001), ACM (aHR, 0.8; 95% CI, 0.7-0.9; P < .001), major amputation (aHR, 0.7; 95% CI, 0.6-0.8; P < .001), and revascularization (aHR, 0.76; 95% CI, 0.7-0.9; P < .001). Among patients with prior BT, redo BT patients were more likely to be smokers (86.2% vs 67.7%; P < .001), present with rest pain (46.7% vs 27.8%; P < .001), and have a lower ABI (0.5 ± 0.5 vs 0.8 ± 0.6; P < .001). Redo BT was associated with improved 1-year major amputation/death (aHR, 0.8; 95% CI, 0.7-0.9; P < .001), ACM (aHR, 0.7; 95% CI, 0.67-0.8; P < .001), major amputation (aHR, 0.8; 95% CI, 0.7-0.9; P = .008), and revascularization (aHR, 0.76; 95% CI, 0.7-0.8; P < .001). These results persisted at 5 years (Table, Figure). The present study shows that revascularization with ET is performed more frequently in patients with prior BT or ET. Despite a higher percentage of smoking, rest pain, and lower ABI in patients undergoing redo BT, BT had better outcomes with improved limb salvage, durability, AFS and ACM (all-cause mortality) compared with redo ET. Future prospective studies are needed to confirm our findings.TableLog-rank test and multivariable Cox regression analysis of 5-year outcomesETBTLog-rankBT vs ETP valueSurvival function (%)Survival function (%)HR (95% CI)Prior PVI Amputation or deatha74.361.5<0.0010.77 (0.7-0.8)<.001 Mortalityb66.451.4<0.0010.78 (0.7-0.8)<.001 Major amputationc25.219.2<0.0010.7 (0.6-0.8)<.001 Revascularizationd6351<0.0010.7 (0.7-0.8)<.001Prior bypass Amputation or deathe74.262.9<0.0010.8 (0.78-0.9)<.001 Mortalityf65.951.2<0.0010.79 (0.7-0.9)<.001 Major amputationg25.223.40.0010.87 (0.78-0.97).013 Revascularizationh63.250.5<0.0010.7 (0.7-0.8)<.001BT, Bypass therapy; CI, confidence interval; ET, endovascular therapy; PVI, peripheral vascular intervention.a Adjusting for age, gender, history of congestive heart failure (CHF), coronary artery disease (CAD), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), preoperative aspirin, preoperative P2Y12 antagonist, preoperative statins, preoperative angiotensin-converting enzyme inhibitors (ACEIs), presenting with rest pain, and below knee intervention.b Adjusting for age, gender, history of CHF, CAD, CKD, COPD, preoperative aspirin, preoperative P2Y12 antagonist, preoperative statins, preoperative ACEIs, and presenting with rest pain.c Adjusting for age, race, history of CHF, CKD, diabetes, preoperative ACEIs, presenting with rest pain, and below-knee intervention.d Adjusting for age, gender, smoking, CKD, preoperative P2Y12 antagonist, presenting with rest pain, and below-knee intervention.e Adjusting for age, gender, race, history of CHF, CAD, CKD, preoperative aspirin, preoperative P2Y12 antagonist, preoperative statins, presenting with rest pain, and below-knee intervention.f Adjusting for age, gender, history of CHF, CAD, CKD, COPD, preoperative aspirin, preoperative P2Y12 antagonist, preoperative statins, preoperative ACEIs, and presenting with rest pain.g Adjusting for age, race, history of CHF, CKD, CAD, preoperative ACEIs, presenting with rest pain, and below-knee intervention.hAdjusting for age, gender, smoking, CKD, preoperative P2Y12 antagonist, presenting with rest pain, preoperative aspirin, preoperative ACEI, preoperative P2Y12 antagonists, and below-knee intervention. Open table in a new tab

Association of proprotein convertase subtilisin/kexin type 9 (PCSK9) levels with abnormally high ankle-brachial index in atrial fibrillation.

High ankle-brachial index (ABI) has been associated with increased risk of worse outcomes in the general population. Few data on atrial fibrillation (AF) do exist. Experimental data suggest that proprotein convertase subtilisin/kexin type 9 (PCSK9) contribute to vascular calcification but clinical data on this association are lacking. We want to investigate the relationship between circulating PCSK9 levels and abnormally high ABI in patients suffering from AF. We analysed data from 579 patients included in the prospective ATHERO-AF study. An ABI ≥1.4 was considered as high. PCSK9 levels were measured coincidentally with ABI measurement. We used an optimized cut-offs of PCSK9 for both ABI and mortality obtained from ROC curve analysis. All-cause mortality according to the ABI value was also analysed. 115 (19.9%) had an ABI ≥1.4. The mean (SD) age was 72.1 (7.6) years and 42.1% of patients were women. Patients with ABI ≥1.4 were older, more frequently male and diabetic. Multivariable logistic regression analysis showed an association between ABI ≥1.4 and serum levels of PCSK9 >1150 pg/ml (odds ratio [OR], 1.649; 95% confidence interval [CI], 1.047-2.598; P = 0.031). During a median follow up of 41 months, 113 deaths occurred. At multivariable Cox regression analysis, ABI ≥1.4 (hazard ratio [HR], 1.626; 95% CI, 1.024-2.582; P = 0.039), CHA₂DS₂-VASc score (HR, 1.249; 95% CI, 1.088-1.434; P = 0.002), antiplatelet drug use (HR, 1.775; 95% CI, 1.153-2.733; P = 0.009), and PCSK9 >2060 pg/ml (HR, 2.200; 95% CI, 1.437-3.369; P <0.001) were associated with all-cause death. In AF patients, PCSK9 levels relate to an abnormally high ABI ≥1.4. Our data suggest a role for PCSK9 in favouring vascular calcification in AF patients.

Endovascular treatment of aorto-iliac occlusive disease with TASC II C and D lesions: 10 year’s experience of clinical technique

ObjectivesThe purpose of this study was to evaluate the therapeutic efficacy and safety of endovascular treatment aorto-iliac occlusive disease (AIOD) with TransAtlantic Inter-Society Consensus II (TASC II) C and D lesions. In addition, 10 years of experience with interventional procedures and treatment options in our center were also worthy of further discussion.MethodsBetween January 2011 and December 2020, a total of 26 consecutive AIOD patients with TASC-II C and D lesions treated endovascular approach were enrolled in this study. Patients' demographic and clinical data were collected, and the safety and efficacy of endovascular therapy were evaluated. In addition, operation procedures were also described.ResultsThe mean age of patients was 62.2 ± 7 years (49–57 years), and the mean body mass index of patients was 24.2 ± 2.6 kg/m2. Fifteen patients (57.7%) were Rutherford 4, 5 each (19.2%) were Rutherford 3 and 5, and 1 (3.8%) was Rutherford 2. No other serious complications occurred except death in 3 patients. Most of the patients (73.1%) had a history of smoking, and hypertension and hyperlipidemia were common comorbidities. Endovascular therapy was successfully performed in 25 patients, and the technical success rate was 96.2%. The patient's ankle-brachial index improved significantly postoperatively compared with preoperatively (preoperative 0.33 ± 0.14 vs 1.0 ± 0.09, P < 0.001). The primary patency rates were 100%, 95.7%, and 91.3% at 1, 3, and 5 years, while the secondary patency rates were 100%. No treatment-related deaths or serious complications occurred.ConclusionsEndovascular treatment of AIOD patients with TASC-II C and D lesions might be safe and have a high rate of middle-term and long-term primary patency.

Association of a low ankle brachial index with progression to end-stage kidney disease in patients with advanced-stage diabetic kidney disease

Introductions The effect of a low ankle-brachial index (ABI) in patients with advanced-stage diabetic kidney disease is not fully understood. This study investigates the prevalence of a low ABI in patients with advanced-stage diabetic kidney disease, which was defined as a urinary albumin-to-creatinine ratio (UACR) ≥300 mg/g and an estimated glomerular filtration rate (eGFR) between 15–60 mL/min/1.73 m2. Furthermore, the association between a low ABI and end-stage kidney disease (ESKD) was determined. Methods This single-center, retrospective, cohort study included 529 patients with advanced-stage diabetic kidney disease who were stratified into groups according to the ABI: high (>1.3), normal (0.9–1.3), and low (<0.9). The Kaplan-Meier method and Cox proportional analysis were used to examine the association between the ABI and ESKD. Results A total of 42.5% of patients with a low ABI progressed to ESKD. A low ABI was associated with a greater risk of ESKD (hazard ratio (HR): 1.073). After adjusting for traditional chronic kidney disease risk factors, a low ABI remained associated with a greater risk of ESKD (HR: 1.758; 95% confidence interval: 1.243–2.487; p = 0.001). Conclusions These results indicate that patients with a low ABI should be monitored carefully. Furthermore, preventive therapy should be considered to improve the long-term kidney survival of patients with residual kidney function.

Paradox of the Relationship between Cardio-Ankle Vascular Index and Ankle-Brachial Index in Patients with Lower Extremity Artery Disease.

Objectives: Measurements of ankle-brachial index (ABI) and toe-brachial index (TBI) are standard examinations for evaluating arterial blood flow in lower extremities and diagnosing lower extremity artery disease (LEAD). It remains to be clarified whether cardio-ankle vascular index (CAVI), a blood pressure-independent parameter of arterial stiffness, is associated with ABI and TBI in patients with LEAD. Methods: The subjects were 165 outpatients with LEAD. Arterial blood flow in lower extremities was evaluated by using ABI, TBI, and the degree of leg exercise-induced reduction of ABI (%). Results: CAVI showed significant positive correlations with ABI and TBI and showed significant inverse correlations with exercise-induced % decrease in ABI. CAVI was significantly higher in the 3rd tertile groups of ABI and TBI than that in the corresponding 1st tertile groups and was significantly lower in the 3rd tertile group of exercise-induced % decrease in ABI than that in the 1st tertile group. The above relationships remained significant after adjustment for age, body mass index, blood pressure, diabetes history, and habitual smoking. Conclusions: Although CAVI is a general parameter reflecting arterial stiffness, CAVI showed paradoxical associations, namely, positive associations with ABI and TBI and an inverse association with exercise-induced % decrease in ABI in patients with LEAD.

Paradox of the Relationship between Cardio-Ankle Vascular Index and Ankle-Brachial Index in Patients with Lower Extremity Artery Disease

Paradox of the Relationship between Cardio-Ankle Vascular Index and Ankle-Brachial Index in Patients with Lower Extremity Artery Disease

Efektifitas Senam Kaki Diabetik terhadap Ankle Brachial Index pada Pasien Diabetes Melitus: Literature Review

Diabetes mellitus is known as "the silent killer" because it can affect all body organs and cause complications, including complications in the feet. These complications can increase the rate of amputations and are life-threatening. Prevention can be done by doing foot exercises. In principle, leg exercises are done by moving all the joints of the legs to improve blood circulation. Blood circulation in the leg area can be measured through the Ankle Brachial Index examination. &#x0D; This study was to identify the effectiveness of diabetic foot exercise.&#x0D; The article search begins with conducting a PICO analysis, then continues with an electronic search for articles using Google Scholar, the year the article was published from 2016 to 2020. The keywords used are "Diabetes Mellitus" and "Leg exercise.” Screening is carried out through inclusion and exclusion criteria to determine the articles to be reviewed. So that articles were obtained that matched the inclusion criteria for review. &#x0D; Results showed nursing interventions for foot exercise on the ankle-brachial index in patients with type II Diabetes Mellitus can be categorized as safe and effective interventions that are given five times a week or for 30 minutes for 5 days or 6x2 a week to reduce the risk of injury to the ankle. foot. Performing effective foot exercises can increase the value of the Ankle Brachial Index to normal. 30-minute foot exercise for 5 days or 6x2 a week should be promoted and implemented as a routine to reduce the risk of injury in patients with diabetes mellitus.&#x0D; In conclusion, foot exercise in type II DM patients can increase the Ankle Brachial Index value which tends to be low to normal.

Literature Review : Efektifitas Senam Kaki terhadap Nilai Ankle Brachial Index (ABI) pada Pasien Diabetes Melitus Tipe 2

Background: Diabetes is a serious long-term condition that significantly impacts the lives and well-being of individuals, families, and communities worldwide. Purpose: This literature review aims to describe the effectiveness of foot exercises on the value of the Ankle Brachial Index (ABI) in Type 2 Diabetes Mellitus patients. Purpose: This literature review aims to describe the effectiveness of foot exercises on the value of the Ankle Brachial Index (ABI) in Type 2 Diabetes Mellitus patients. Methods: This scientific paper is a literature review search using an electronic database: Google Scholar, Semantic Scholar, and Pubmed. The keywords used in the search are Diabetes Mellitus Type 2 or Diabetes Mellitus Type 2, Foot exercise or Foot exercise, and Ankle Brachial Index or Ankle Brachial Index. The inclusion criteria used in the article are accessible full-text manuscripts, in English and Indonesian, free of charge, the journal year used is limited to the last 10 years, the results are found each 1 article from Semantic Scholar and 3 Google Scholar, from 4 articles discussing the effectiveness of foot exercise on the value of the ankle-brachial index in patients with type 2 diabetes mellitus. Results: The analysis of 4 articles showed an increase in value; the most effective research was in Wahyuni's research in 2016, conducted within 3 days with an increase in value of 0.31. Conclusion: In reviewing this literature review, it can be concluded that the effectiveness of foot exercises on the value of the Ankle Brachial Index in Type 2 Diabetes Mellitus patients.

Abnormal Calcium Metabolism Mediated Increased Risk of Cardiovascular Events Estimated by High Ankle-Brachial Index in Patients on Peritoneal Dialysis.

Cardiovascular disease (CVD) is the leading cause of death in peritoneal dialysis (PD) patients. But the relationship between regular PD and the risk of major adverse cardiovascular events (MACE) remains controversial. The possible risk factors are not fully elucidated. This study aims to investigate the possible factors affecting the risk of MACE estimated by high ankle-brachial index (ABI) in PD patients. A total of 243 patients were enrolled and divided into chronic kidney diseases (CKD) stage 1, non-dialyzed CKD stages 2–5, and PD groups. The prevalence of high ABI, indicating increased MACE, was elevated with CKD progression but not further increased in PD patients. Systolic blood pressure was closely correlated with high ABI in non-dialyzed CKD patients (β = 0.059, P = 0.001). But in PD patients, serum calcium had a crucial effect on high ABI (β = −9.853, P < 0.001). Additionally, PD patients with high ABI tended to dialyze inadequately (Kt/V <1.7) compared to those with normal ABI (29.0 vs. 13.3%, P = 0.031). Further mediation analysis revealed that ~86.2% of the relationship between Kt/V and high ABI was mediated by serum calcium in PD patients (mediation effect = 86.2%, ab = −0.220, 95% CI: −0.381 to −0.059, P = 0.008), especially in those starting PD before 55 years of age and with normal body mass index. This present study indicated that improvement of PD adequacy by maintaining calcium balance might be a promising method to reduce the risk of MACE estimated by high ABI for PD patients.

The Relationship between SYNTAX Score and Resting/Post-exercise Ankle-Brachial index in Patients with Acute Coronary Syndrome

The Relationship between SYNTAX Score and Resting/Post-exercise Ankle-Brachial index in Patients with Acute Coronary Syndrome

Prognostic value of low ankle-brachial index in patients with resistant hypertension

In the presence of resistant hypertension, patients have a significantly higher risk of stroke, myocardial infarction, kidney disease, heart failure, and death than patients with elevated blood pressure. Increased arterial stiffness is an important factor in determining cardiovascular risk. Peripheral artery damage is a target organ lesion, and its presence puts the patient at high or very high risk. The simplest non-invasive method of detecting peripheral vascular damage in patients is to determine the ankle-brachial index (ABI). Aim. To detect the frequency of damage to the lower extremity peripheral arteries by determining the ankle-brachial index and its impact on the subsequent prognosis in patients of older age (&gt;55 years) with resistant hypertension using automatic blood pressure monitors. Materials and methods. The object of the study were patients with hypertension aged 55 years – 150 people with elevated blood pressure of the 3rd degree and 20 healthy people of the same age. The study included only those patients who did not have clinical symptoms of peripheral vascular disease, type 2 diabetes mellitus. Determination of the ABI was performed by an automatic device. Results. The frequency of femoral artery lesions detection by measuring blood pressure on the brachial and legs in asymptomatic patients with resistant hypertension was 14.0 %. For a detailed analysis, we divided all patients with hypertension depending on the value of the ABI into two subgroups: subgroup A included patients (n = 129) with an ABI value &gt;0.9, subgroup B (n = 21) – with the value of ≤0.9. In patients with resistant hypertension and peripheral arterial disease, the more common factors were: longer duration of hypertension, the presence of isolated systolic hypertension and a lower level of glomerular filtration rate. Decreased ABI (≤0.9) in patients with resistant hypertension was associated with a 1.4-fold increased risk of adverse cardiovascular complications and a 1.9-fold increased risk of all-cause mortality. Conclusions. In patients with resistant hypertension, a reduced ankle-brachial index was associated with a 1.4-fold increased risk of adverse cardiovascular complications and a 1.9-fold increased risk of all-cause mortality.

No false elevation in ankle brachial index in patients with tibial plateau fractures and vascular risk factors

ObjectivesThe ankle brachial index (ABI) is a useful tool in detection of lower extremity vascular injury. However, diabetes mellitus (DM), chronic kidney disease (CKD), and peripheral vascular disease (PVD) may affect extremity perfusion leading to possible false elevation of the ABI value. If true in trauma patients, this can affect initial evaluation, diagnostics, and management. We therefore explored mean ABI values in tibial plateau fractures of patients with vascular risk factors to help determine whether there is a difference. DesignThis is a retrospective chart review of patients sustaining tibial plateau fractures with a specific ABI value recorded in the medical record. Patients were identified as either having vascular risk factors or not and data analysis performed to determine if their ABI differed and whether they were more likely to have a vascular injury. Results282 acute tibial plateau injuries with specific ABI values were identified, 46 of which carried the risk factors in question. The average risk factor group ABI was 0.95 ± 0.15 versus those without risk factors 1.0 ± 0.15 (p = 0.057). No patient with risk factors required a vascular intervention or four-compartment fasciotomy. ConclusionsThis study shows no statistical significance between the presenting ABI of patients with risk factors such as DM, CKD, or PVD and those without those risk factors who sustained acute tibial plateau fractures. Therefore, in general the ABI still holds as a useful screening tool for evaluation of vascular insult in the setting of acute lower extremity trauma.

Factors Affecting the Value of Ankle Brachial Index in Patients with Diabetes Mellitus Type 2: Literature Review

Aims: The purpose of this literature review is to determine the factors that affect the value of the Ankle Brachial Index (ABI) in patients with type 2 diabetes mellitus. Methods: Search articles through Pubmed, Science Direct, Scopus and Researchgate. The articles obtained were filtered based on full text, 20 articles were found, and six articles were analyzed through analysis of objectives, suitability of topics, research methods used, characteristics of respondents, and the results of each article, published 2017-2021, in English and Indonesian. Results: ABI value in people with diabetes is influenced by age with a lower prevalence of ABI higher in men, treatment with oral anti-diabetic or insulin, mean arterial pressure, the severity of diabetic foot, and the presence of symptoms of complications of diabetes mellitus such as diabetic retinopathy. However, the duration of suffering from diabetes mellitus did not affect the abnormal ABI value. Conclusion: The Ankle Brachial Index (ABI) value can be influenced by Age, Gender, the severity of diabetic foot, and symptoms of complications, but the length of suffering from Diabetes Mellitus does not affect the ABI value.

Long-Term (7-Year) Clinical Implications of Newly Unveiled Asymptomatic Abnormal Ankle-Brachial Index in Patients With Coronary Artery Disease.

BackgroundThe long‐term impact of newly discovered, asymptomatic abnormal ankle–brachial index (ABI) in patients with significant coronary artery disease is limited.Methods and ResultsBetween January 2006 and December 2009, ABI was evaluated in 2424 consecutive patients with no history of claudication or peripheral artery disease who had significant coronary artery disease. We previously reported a 3‐year result; therefore, the follow‐up period was extended. The primary end point was a composite of all‐cause death, myocardial infarction (MI), and stroke over 7 years. Of the 2424 patients with significant coronary artery disease, 385 had an abnormal ABI (ABI ≤0.9 or ≥1.4). During the follow‐up period, the rate of the primary outcome was significantly higher in the abnormal ABI group than in the normal ABI group (P<0.001). The abnormal ABI group had a significantly higher risk of composite of all‐cause death/MI/stroke than the normal ABI group, after adjustment with multivariable Cox proportional hazards regression analysis (hazard ratio [HR], 2.07; 95% CI, 1.67–2.57; P<0.001) and propensity score–matched analysis (HR, 1.97; 95% CI, 1.49–2.60; P<0.001). In addition, an abnormal ABI was associated with a higher risk of all‐cause death, MI, and stroke, but not repeat revascularization.ConclusionsAmong patients with significant coronary artery disease, asymptomatic abnormal ABI was associated with sustained and increased incidence of composite of all‐cause death/MI/stroke, all‐cause death, MI, and stroke during extended follow‐up over 7 years.

EFFECT OF LEG EXERCISE ON THE ANKLE BRACHIAL INDEX (ABI) OF TYPE 2 DIABETES MELLITUS PATIENTS IN REJANG LEBONG REGIONAL HOSPITAL

Introduction: Peripheral arterial disease often occurs in patients with type 2 diabetes mellitus. Peripheral arterial disease in patients with type 2 diabetes mellitus occurs due to decreased blood circulation in the lower extremities. Looking at the value of the ankle-brachial index is one of the actions that can be taken to detect peripheral arterial disease. Objective: The purpose of this study was to determine the effect of a foot exercise intervention on the ankle-brachial index value of type 2 diabetes mellitus patients. Methods: This research was a quantitative research with a pre-experimental design, with one pre-test and post-test design. The research was carried out at Rejang Lebong Hospital from August to November 2020. The number of samples used in this study were 35 patients experiencing type 2 diabetes mellitus for more than five years. The analysis used in this study was the Wilcoxon test. Results: The results showed a difference in the mean of the ankle-brachial index before (1.02) and after (1.12) the intervention. Thus, there was an increase of 0.10 in the average value of the ankle-brachial index. The analysis result of this study showed the value of p = 0.001 (p&lt;0.05). Conclusion: Foot exercise can be used as an alternative intervention to increase the value of the ankle-brachial index in patients with type 2 diabetes mellitus.

Relationship Between Medication Adherence and Ankle-Brachial Index Value in Patients With Hypertention

Background: Hypertension is one of the leading causes of death and physical disabilities. The ankle-brachial index (ABI) is one of the useful indicators of blood pressure with the ability to show the risk of peripheral artery disease. This study aims to investigate the relationship between medication adherence and the ABI lavue in patients with hypertension. Methods: In this descriptive cross-sectional study, 250 patients with hypertension referred to medical health centers in Karaj, Iran were enrolled using a convenience sampling method. To collect data, a demographic form and the 8-item morisky medication adherence scale (MMAS-8) were used. Also, the ABI was measured manually using an acoustic Doppler probe. Data were analyzed in SPSS software, v. 25. Findings: The Mean±SD of the right and left ABI were 1.055±0.134 and 1.036±0.113, respectively. The Mean±SD of MMAS-8 score was 5.88±1.74. It was found that 127 patients (50.8%) had low adherence level, 68 (27.2%) had moderate adherence level, and only 55 (22%) had high adherence level. There was a positive significant correlation between patients’ medication adherence and the ABI value. Moreover, a statistically significant difference was observed in the mean scores of the ABI in patients with three different levels of medication adherence. Conclusion: The medication adherence is poor among hypertensive patients in Karaj. It is related to the ABI such that with the decrease of medication adherence, the ABI value decreases. Therefore, adherence to medication regimen in patients with hypertension can be effective in preventing arterial complications.