Ankle Brachial Pressure Index Measurement Research Articles

Comparison of the Automated Oscillometric Method With the Gold Standard Doppler Ultrasound Method to Access the Ankle-Brachial Pressure Index

Despite its screening interest, the ankle-brachial pressure index (ABPI) remains uncommon in general practice, because it needs training and specific devices as Doppler. Easier methods such as the use of automated oscillometric devices may facilitate the peripheral arterial diseases (PADs) screening. We wanted to assess the reliability of the automated oscillometric measurement of the ABPI, compared with the gold standard Doppler ultrasound measurement. In 287 patients aged 65 years or older without diagnosed PAD, we performed ABPI measurements with oscillometric and Doppler devices. Reproducibility was assessed by the intraclass correlation coefficient of agreement (R) and the Bland and Altman method. The intermethod reliability was bad (R = .346, 95% CI = (0.268-0.420)), with a large confidence interval of the individual differences between the 2 methods: 95% CI = (-0.183-0.346). Automatic oscillometric devices cannot be recommended as reliable methods for ABPI measurement.

Automated Ankle-Brachial Pressure Index Measurement by Clinical Staff for Peripheral Arterial Disease Diagnosis in Nondiabetic and Diabetic Patients

Clairotte et al. (1) recently reported in Diabetes Care that the oscillometric measurement of the ankle-brachial index (Osc-ABI) has lower diagnostic performance in diagnosing peripheral arterial disease (PAD) in diabetic patients when compared with the Doppler-measured ankle-brachial pressure index (Dop-ABI). Our group has validated the use of an automatic oscillometer (Omron M-7) for Osc-ABI calculation. We chose this model because the sleeve adapts better to the truncated cone morphology of the leg. We used the Doppler Hadeco Bidop (Koven Technology, St. Louis, MO) to measure the sonorous and graphical signal. For the Osc-ABI calculation, three measurements were made and the greatest of …

Automated Ankle-Brachial Pressure Index Measurement by Clinical Staff for Peripheral Arterial Disease Diagnosis in Nondiabetic and Diabetic Patients

Gomez-Huelgas et al. (1) reported on the use of oscillometric measurement of the ankle-brachial index (Osc-ABI) in diabetic and nondiabetic patients for diagnosis of occlusive peripheral arterial disease (PAD). That study was similar to our previous research (2), although important methodological differences may be noted, especially with the use of magnetic resonance angiography imaging and not ultrasound as a gold standard technique. Consistent with our study, Gomez-Huelgas et al. …

043 Does routine measurement of ankle brachial index ameliorates the assessment of coronary risk level in patients with known or suspected coronary artery disease. The ABICARD study

Ankle-brachial pressure index (ABI) is an independent predictor of the extent of coronary atherosclerosis and cardiovascular events. To date ABI measurement is not part of the routine examination in patient admitted for coronary angiography. Our objective was to establish ABI measurement as a routine procedure in our interventional cardiology unit to ameliorate the assessment of coronary risk level for patients admitted for scheduled coronary angiography. ABI measurement was performed on admission using a doppler ultrasonic instrument. Patients with past medical history of peripheral arteriopathy were excluded. Cardiovascular risk factors and clinical findings were collected. Correlations and multivariate analysis were performed on R software. In the pilot study, 40 consecutive patients were included between February and April 2009. 79% were males and the mean age was 66+/-12 years. ABI < 0.9 was found in 6 patients. Significant multivessel disease was found in 10 patients: 6 with ABI<0.9 and 4 with ABI≥0.9. Patients with ABI<0.9 were significantly older 75+/-11 vs 64+/-12 (p=0.04) and had a trend for lower glomerular filtration rate MDRD=61+/-21 vs 77+/-20 mL/min/1.73m_ (p=0.08). 5-years probability of cardiovascular death was 12+/-7.4% in patients with ABI<0.9 vs 7.2+/-7.6 in patients with ABI≥0.9 (p=ns). Multivariate analysis showed that ABI remains a significant predictor of multivessel disease after adjustment on other risk factors. Low ABI was significantly correlated with 5 years probability of cardiovascular death (spearman = −0.36, P=0.03). ABI was an independent predictor of coronary multivessel disease and 5 years probability of cardiovascular death. Routine ABI measurement in patients with known or suspected coronary artery disease provides additional information regarding patient's risk and may be taken into account to establish optimal care strategy.

Peripheral arterial disease in diabetes—a review

Diabetic patients are at high risk for peripheral arterial disease (PAD) characterized by symptoms of intermittent claudication or critical limb ischaemia. Given the inconsistencies of clinical findings in the diagnosis of PAD in the diabetic patient, measurement of ankle-brachial pressure index (ABI) has emerged as the relatively simple, non-invasive and inexpensive diagnostic tool of choice. An ABI < 0.9 is not only diagnostic of PAD even in the asymptomatic patient, but is also an independent marker of increased morbidity and mortality from cardiovascular diseases. With better understanding of the process of atherosclerosis, avenues for treatment have increased. Modification of lifestyle and effective management of the established risk factors such as smoking, dyslipidaemia, hyperglycaemia and hypertension retard the progression of the disease and reduce cardiovascular events in these patients. Newer risk factors such as insulin resistance, hyperfibrinogenaemia, hyperhomocysteinaemia and low-grade inflammation have been identified, but the advantages of modifying them in patients with PAD are yet to be proven. Therapeutic angiogenesis, on the other hand, represents a promising therapeutic adjunct in the management of PAD in these patients. Outcomes after revascularization procedures, such as percutaneous transluminal angioplasty and surgical bypasses in diabetic patients, are poorer, with increased perioperative morbidity and mortality compared with that in non-diabetic patients. Amputation rates are higher due to the distal nature of the disease. Efforts towards increasing awareness and intensive treatment of the risk factors will help to reduce morbidity and mortality in diabetic patients with PAD.

Role of ankle-brachial pressure index as a predictor of coronary artery disease severity in patients with diabetes mellitus

Previous studies have reported a close correlation between low ankle-brachial pressure index (ABPI) and various cardiovascular risk factors. However, despite the well-established potential hazards of consequent coronary artery disease (CAD), no data exist on the relationship between ABPI and the severity of CAD, particularly in patients with diabetes mellitus (DM). A total of 840 patients ranging from 35 to 87 years of age (mean [+/- SD] 63.9+/-10.2 years) with suspected CAD in a clinical practice were enrolled. All patients underwent ABPI measurements and coronary angiography. Patients were divided into four groups according to the results of ABPI measurements and the presence or absence of DM: group A had an ABPI value of at least 0.9 but no DM (A-/D-); group B had an ABPI value of at least 0.9 and DM (A-/D+); group C had an ABPI of less than 0.9 but no DM (A+/D-); and group D had an ABPI value of less than 0.9 and DM (A+/D+). Age was significantly higher in the A+ (groups C and D) than the A- patients (groups A and B). Moreover, men predominated in all four groups. Comparisons of sex distribution among the four groups revealed that group D had the highest percentage of women, while group A had the lowest. Total cholesterol level did not differ among the four groups, although group D tended to have the highest result. Patients in group D had the highest percentages of hypertension, hypercholesterol, hypertriglyceride, low high-density lipoprotein cholesterol and high low-density lipoprotein cholesterol among the four groups. Group D exhibited the highest triglyceride and uric acid levels, the lowest high-density lipoprotein cholesterol level, and the highest metabolic syndrome criteria number and percentage of metabolic syndrome. Furthermore, group D had the highest mean lesion numbers, mean numbers of target vessel involvement, stenoses with type C classification and complex morphology lesions (chronic total occlusion, diffuse or calcified lesions) among the four groups. There were still significant differences in lesion numbers (P<0.001) and numbers of target vessel involvement (P<0.001) for ABPI predicting CAD severity after controlling for the effects of DM and age. The sensitivity, specificity, positive predictive value and negative predictive value of using an ABPI of less than 0.9 to predict CAD differed significantly between patients with and without DM. ABPI is a useful noninvasive tool for predicting CAD severity, even in patients with DM.

Automated Ankle-Brachial Pressure Index Measurement by Clinical Staff for Peripheral Arterial Disease Diagnosis in Nondiabetic and Diabetic Patients

OBJECTIVEPeripheral arterial disease (PAD) is a prognostic marker in cardiovascular disease. The use of Doppler-measured ankle-brachial pressure index (Dop-ABI) for PAD diagnosis is limited because of time, required training, and costs. We assessed automated oscillometric measurement of the ankle-brachial pressure index (Osc-ABI) by nurses and clinical staff.RESEARCH DESIGN AND METHODSClinical staff obtained Osc-ABI with an automated oscillometric device in 146 patients (83 with diabetes) at the time of Dop-ABI measurement and ultrasound evaluation.RESULTSMeasurements were obtained in most legs (Dop-ABI 98%; Osc-ABI 95.5%). Dop- and Osc-ABI were significantly related in diabetic and nondiabetic patients with good agreement over a wide range of values. When Dop-ABI ≤0.90 was used as the gold standard for PAD, receiver operating characteristic curve analysis showed that PAD was accurately diagnosed with Osc-ABI in diabetic patients. When ultrasound was used to define PAD, Dop-ABI had better diagnostic performance than Osc-ABI in the whole population and in diabetic patients (P = 0.026). Both methods gave similar results in nondiabetic patients. The cutoff values for the highest sensitivity and specificity for PAD screening were between 1.0 and 1.1. Estimation of cost with the French medical care system fees showed a potential reduction by three of the screening procedures.CONCLUSIONSPAD screening could be improved by using Osc-ABI measured by clinical staff with the benefit of greater cost-effectiveness but at the risk of lower diagnostic performance in diabetic patients.

Selective and Sustained Delivery of Basic Fibroblast Growth Factor (bFGF) for Treatment of Peripheral Arterial Disease: Results of a Phase I Trial

The aim of this study was to evaluate the safety of selective and sustained delivery of basic fibroblast growth factor (bFGF) using acidic gelatine hydrogel microspheres (AGHMs) for the treatment of peripheral arterial disease (PAD). We conducted a non-randomised and uncontrolled trial involving prospective observation of eight patients (eight limbs) with PAD - five limbs with arteriosclerosis obliterans and three limbs with thromboangiitis obliterans, five limbs (three arms and two legs) with critical limb ischaemia (CLI) and three limbs with intermittent claudication (IC) - who were followed up for 6 months or more. AGHM suspension containing 100 microg bFGF was infused into the artery of the affected limb. Besides evaluation of safety and changes in symptoms, resting ankle-brachial pressure index measurement and transcutaneous PO(2) (tcPO(2)), angiography were conducted at baseline and then at various time points. Skin perfusion pressure as an index of CLI and claudication distance as an index of IC were also used to assess clinical improvement and limb perfusion. No serious adverse events were observed. All cases showed improvement in symptoms, although this was temporary in some patients. Selective delivery of bFGF using AGHMs was suggested to be safe and well-tolerated in patients with PAD.

Pulse oximetry index: a simple arterial assessment for patients with venous disease

To provide additional safety data comparing ankle brachial pressure index (ABPI) and pulse oximetry (Lanarkshire Oximetry Index, LOI) as measures of arterial circulation in patients with venous disease of the leg. A total of 107 (195 legs) attending hospital leg ulcer clinics participated in this prospective open study. We attempted to measure brachial and foot arterial pressures in all patients using both the handheld Doppler method (ABPI) and pulse oximeter method (LOI). Features of patients with limbs in which either the ABPI or LOI could not be assessed were documented. ABPI and LOI values were compared, and agreement between the two assessment methods was assessed. We found the LOI measurement to be a simpler technique than Doppler ABPI measurement, with an endpoint less prone to the subjective variability associated with the Doppler method. Of the 195 legs assessed,we obtained LOI in 10 in which an ABPI could not be recorded. LOI could not be recorded in only one leg. There was a linear association (p<0.001) and fair agreement (kappa=0.303) between LOI and ABPI in the 184 legs in which both ratios could be measured. There was no evident tendency for LOI to read either low or high compared with ABPI. Pulse oximetry LOI is a simple alternative to Doppler ABPI in the screening of patients for arterial disease that could be a contraindication to, or require modification of, compression therapy. It can be measured in some legs that cannot be assessed by Doppler ultrasound.

Ankle Brachial Pressure Index Measurement And Its Correlation To Claudication In Patients With Scleroderma

Systemic sclerosis (SSc) is a generalized disorder of connective tissue characterized clinically by thickening and fibrosis of skin (scleroderma). Raynaud's phenomenon and microcirculatory abnormalities are well recognized manifestations of this disease.Macrovascular disease has a significant impact on the course of the disease and a major cause of morbidity in the form of claudication, loss of digit or limb or cardiovascular events. In our study of 62 patients, 47(75.80%) patients had symptomatic peripheral vascular disease(PVD) measured by Edinburgh claudication score where as prevalence of objective PVD in these patients as measured by ankle brachial pressure index(ABPI) was seen only in 31(50%) of the patients. An ABPI value of less than 0.9 was more closely associated with clinical claudication than the ABPI value of 1 in our study.20 out of the 30 patients with a positive anticardiolipin antibody had an ABPI of <1(p value = 0.0312) which is considered as significant. 12(65%) of the 19 dyslipidemic patients had an ABPI of <1 indicating a correlation between ABPI and dyslipidemia.Thus ABPI is a simple non invasive reproducible tool to assess PVD in patients with scleroderma

A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease

Ankle-brachial pressure index (ABI) is a simple, inexpensive, and useful tool in the detection of peripheral arterial occlusive disease (PAD). The current guidelines published by the American Heart Association define ABI as the quotient of the higher of the systolic blood pressures (SBPs) of the two ankle arteries of that limb (either the anterior tibial artery or the posterior tibial artery) and the higher of the two brachial SBPs of the upper limbs. We hypothesized that considering the lower of the two ankle arterial SBPs of a side as the numerator and the higher of the brachial SBPs as the denominator would increase its diagnostic yield. The former method of eliciting ABI was termed as high ankle pressure (HAP) and the latter low ankle pressure (LAP). ABI was assessed in 216 subjects and calculated according to the HAP and the LAP method. ABI findings were confirmed by arterial duplex ultrasonography. A significant arterial stenosis was assumed if ABI was <0.9. LAP had a sensitivity of 0.89 and a specificity of 0.93. The HAP method had a sensitivity of 0.68 and a specificity of 0.99. McNemar's test to compare the results of both methods demonstrated a two-tailed P < .0001, indicating a highly significant difference between both measurement methods. LAP is the superior method of calculating ABI to identify PAD. This result is of great interest for epidemiologic studies applying ABI measurements to detect PAD and assessing patients' cardiovascular risk.

Reliability of ankle:brachial pressure index measurement by junior doctors.

Ankle:brachial pressure index (ABPI) measurements are often performed by junior medical staff with little experience of the technique. The accuracy of such measurements is unknown. Two newly qualified doctors with no training in the use of Doppler ultrasonographic flowmeters performed ABPI measurement in 38 limbs (experiment 1). Two other newly qualified doctors then underwent a formal training session before, as well as continuous instruction during, ABPI measurements in 23 limbs (experiment 2). The doctors' measurements were compared with those obtained by experienced vascular technicians. The mean difference in ABPI measurement between the doctors and technicians in experiment 1 was greater than that in experiment 2 at both the dorsalis pedis (P < 0.05) and posterior tibial arteries. Nearly 30 per cent of the doctors' ABPI measurements in experiment 1 differed from those of the technicians by more than 0.15, in comparison with only 15 per cent of the measurements performed in experiment 2. Junior doctors should undergo formal training before performing ABPI measurements.

Community nurse use of Doppler ultrasound in leg ulcer assessment

Doppler ultrasound is used by community nurses to measure the ankle brachial pressure index (ABPI). This is required before applying compression therapy for patients with chronic venous insufficiency and venous leg ulcers.However, emphasis on the ABPI result has resulted in inappropriate referrals to the vascular department which led the author to survey current practice within one primary care trust. Results illustrated variations in how nurses obtain training and maintain their competency in using Doppler ultrasound. This has an impact on the accuracy of interpretation of the ABPImeasurement and subsequent management of the patient. Practical issues also explained the difficulties nurses encountered in using the correct procedure within the community, which may result in unreliable measurements. There is a need to standardize training for all community nurses, and to review the structure of current clinical guidelines to enable a wider analysis of arterial assessment, in order to reduce the emphasis purely on the ABPI measurement.

Swiss Atherothrombosis Survey: a field report on the occurrence of symptomatic and asymptomatic peripheral arterial disease

To investigate the Ankle/Brachial Pressure Index (ABI) for its suitability in daily practice to identify patients at atherothrombotic risk. To collect data on the prevalence of atherothrombotic events [coronary artery disease (CAD), stroke/transient ischaemic attack (TIA)], of 'hidden' (asymptomatic) versus 'known' (symptomatic) peripheral arterial disease (PAD) and treatment in the general practice population. Field survey from everyday Swiss practice. On five consecutive workdays, 276 doctors documented all patients, recording gender, age, history of atherothrombotic events, risk factors and family history. In the case of a previous stroke/TIA and/or CAD, or two or more risk factors were present at age >55, the ABI was determined. A total of 25,351 patients were included and 3921 ABI measurements were performed in eligible patients. Practices of primary care doctors. All patients who visited one of the 276 participating doctors on one of five consecutive workdays were included in the survey. Data recording and measurement of the ABI on those patients who qualified. Of the patients 3.7% had symptomatic PAD. An additional 2.7% of hitherto asymptomatic patients were identified as being at high atherothrombotic risk by having an ABI value <0.9. Exactly 93.9% of the participating doctors considered the ABI measurement easy to incorporate into the diagnostic routine of patients presenting with risk factors. The ABI measurement is an easy-to-use, noninvasive and reliable means to identify patients at risk of atherothrombotic events. Identification of asymptomatic PAD leads to intensified targeted prophylactic atherothrombotic treatment that can reduce morbidity and mortality.

Ankle brachial pressure index and carotid intima-media thickness as atherosclerosis markers in Japanese diabetics

The aim of this study was to assess the clinical significance of ankle brachial pressure index (ABI) and carotid intima-media thickness (IMT) in Japanese patients with type 2 diabetes. ABI and ultrasonographic carotid IMT measurements were made in 1311 patients and the relationships between ABI, IMT, and cardiovascular diseases were examined. Patients were assigned to one of three groups depending on their ABI index: (i) ABI ≥ 1.0; (ii) ABI from ≥0.9 to <1.0; and (iii) ABI < 0.9. The odds ratios (ORs) for groups (ii) and (iii) compared with (i) for the prevalence of coronary heart disease (CHD), cerebrovascular disorder (CVD), and carotid atherosclerosis (mean carotid IMT ≥ 1.1 mm) demonstrated that these conditions were inversely related to ABI. As the combined ABI/carotid IMT score increased, each OR for the prevalence of CHD and CVD increased significantly. This suggests that a lower ABI is associated with generalized atherosclerosis. Measurements of the ABI and carotid IMT might provide a good prognostic indicator, and both should be assessed during screening for atherosclerosis in Japanese patients with type 2 diabetes.

Is the Stresst'er a Reliable Stress Test to Detect Mild to Moderate Peripheral Arterial Disease?

Background. A stress test is required in patients with a resting ankle brachial pressure index (ABPI) of >0.9 in whom peripheral arterial disease (PAD) is suspected. Objective. To see if the Stresst'er Ergometer could mimic a standard 1 min treadmill exercise test and successfully diagnose the presence of significant PAD. Methods. Legs with a resting ABPI >0.9, a positive exercise test and PAD confirmed on Duplex ultrasound, underwent various protocols on the Stresst'er Ergometer. The results were compared to control legs with no PAD (normal stress test). Results. By making various adjustments to the rate and duration of the exercise, the resistance provided by the Stresst'er to the exercise and the timing of the post exercise ABPI measurement it was possible to accurately diagnose significant PAD. Conclusion. Using an appropriate protocol it is possible to use the Stresst'er Ergometer to assist in the diagnosis of significant PAD. Being a portable, space saving device, the Stresst'er offers the opportunity of diagnosis outside the vascular laboratory. This would facilitate medical therapy to at risk patients.

A comparison of patients who developed venous leg ulceration before and after their 50th birthday

Background: although chronic venous ulceration (CVU) is often viewed primarily as a disease of the elderly, recent epidemiological data suggest that a significant proportion of patients first develop CVU before middle age. Such patients may represent a distinct group in terms of aetiology, natural history, prognosis and therapeutic options. Aim: to compare patients who developed CVU before (Group 1) and after (Group 2) their 50th birthday. Methods: one hundred and eighteen consecutive patients with “pure” CVU underwent history and examination, measurement of ankle-brachial pressure index (ABPI) and duplex ultrasound examination of the affected limb. Pure venous ulcers were defined as those of >4 weeks duration in the presence of venous reflux (>0.5) and in association with an ankle: brachial pressure index of >0.8. Results: patients in Group 1 (n = 54, 46%) were more likely to be male (32/54 [59%] vs 14/64 [23%], p < 0.001 χ2), to have a higher median (interquartile [IQR]) body mass index (32 [27-39] vs 27 [23-34], p = 0.003, Mann-Whitney U [MWU]), to have a history of deep venous thrombosis (23/54 [43%] vs 16/64 [25%], p = 0.04 χ2) and of ipsilateral long bone fracture (13/54 [24%] vs 5/64 [8%], p = 0.01, χ2), to have previously undergone venous surgery (27/54 [50%] vs 19/64 [30%] a median (IQR) of 11.5 (6.5-19) and 10 (2-20) years earlier respectively, and to have worse disease in terms of the duration of present ulcer (12 (6-36) vs 8.5 [3-18] months, p = 0.035 MWU), the total duration of ulcer disease (216 [72-360] vs 48 [12-120] months, p < 0.001 MWU), and the number of episodes of ulceration (3 [2-7] vs 1 [1-3], p = 0.002 MWU). There was no significant difference between the two groups in the pattern and severity of venous reflux with 46/54 (85%) of Group 1 and 54/64 (84%) of Group 2 patients having surgically correctable superficial venous reflux. Conclusion: patients who develop CVU before their 50th birthday appear to represent a distinct group in terms of aetiology, natural history and prognosis. The importance of thrombo-embolic prophylaxis in the prevention, and the detection and correction of superficial venous reflux in the treatment, of such ulcers is re-emphasised.Eur J Vasc Endovasc Surg 26, 176-178 (2003)

IMPROVED FUNCTIONAL CAPACITY IS INDEPENDENT OF CHANGES IN ANKLE BLOOD PRESSURE FOLLOWING EXERCISE TRAINING IN PVD.

PURPOSE It is widely believed that improvements in walking distance are related to increased blood flow following exercise training in patients with peripheral vascular disease (PVD). Therefore, the ankle brachial pressure index (ABPI) is commonly assessed. METHODS In this study, 17 patients with PVD were randomised to a 6 wk exercise rehabilitation programme (ER; n=9) or to a control group given usual care (exercise advice;CONT; n=8). Before and after intervention, both groups performed; i) graded treadmill exercise to determine maximal walking distance (MWD), pain free walking distance (PFWD), peak oxygen consumption (VO2peak), peak ventilation (VE), and respiratory exchange ratio (RER); and ii) measurement of ABPI by means of a Doppler, at rest and immediately after treadmill testing. RESULTS At baseline, all parameters were similar between ER and CONT. ABPI tended to fall after graded exercise in both groups (0.58±0.30 to 0.40±0.40; ER, P=0.06; 0.85±0.20 to 0.60±0.40; CONT,P=0.06). After intervention, MWD in ER increased from 300±198 to 514±226 m; (p < 0.05) but was unchanged in CONT (460±200 vs. 430±151 m; P=NS). Similarly VO2peak increased after ER (14.7±3.0 vs 19.4 ±5.0 mlO2/kg/min; p < 0.05) but was unchanged in CONT (18.2±4.0 vs. 17.6±3.0 mlO2/kg/min;P=NS). However, resting (0.58±0.30 vs. 0.40±0.50 ER, P=NS; 0.85±0.20 vs. 0.60±0.10; CONT, P=NS) and post exercise (0.40±0.40 vs. 0.41±0.40; ER, P=NS; 0.60±0.40 vs. 0.55±0.30; CONT, P = NS) ABPI were unchanged in either group after intervention. CONCLUSIONS Improvements in MWD and VO2peak following exercise training occur without improvement in the ABPI. Thus the use of a graded exercise test to monitor functional capacity in patients with PVD is superior to using the ABPI.

Ankle–brachial Index and Mortality in a Cohort of Questionnaire Recorded Leg Pain on Walking

Objective: to study the association between the ankle–brachial pressure index (ABPI), premature death and the need for surgical treatment for lower limb ischaemia. Design: population based cohort study. Subjects: three hundred and fifty-three men and women, 50–89 years old, underwent a leg pain questionnaire and measurement of ABPI and was then followed for 10 years. Outcome Measures: all cause mortality, vascular procedures and major amputations. Results: a low ABPI was independently associated with premature all cause mortality in the multiple regression analysis, carrying a relative risk of 3.4 (95% confidence interval 2.0–5.9) and 2.1 (1.3–3.3) for ABPIs ≤0.50 and 0.51–0.80, respectively, compared to those with ABPI ≥1.0. Individuals with an ABPI in the interval 0.81–0.99 suffered only a slight, not statistically significant risk increase compared to normals. A low ABPI at baseline implied a continuous constant increased risk of death throughout the study period. The same risk was observed among elderly (70–89, median 77 years), and in the middle aged (50–69, median 63 years) individuals. The vast majority of those subjected to vascular intervention or major amputation during follow-up had an ABPI≤0.8 at baseline (83 and 89%, respectively). However, within that group, the individual ABPI was not predictive for surgical intervention. Conclusion: the association found between an ABPI ≤0.8 and premature mortality in this cohort of symptomatic subjects implies that the ABPI is a powerful, independent predictor for premature death. The prognostic information carried by an ABPI in the interval 0.81–0.99 remains uncertain. Septuagenarians and octogenarians carry the same risk increase associated with a low ABPI as those in the middle ages.

Whole-body (201)Tl scintigraphy can detect exercise lower limb perfusion abnormalities in asymptomatic diabetic patients with normal Doppler pressure indices.

Significant lower limb arterial obstruction is usually detected by Doppler ankle-brachial pressure index (ABPI) measurement. However, ABPI is non-contributory in cases of diabetic medial sclerosis or calcifications and is unsuitable for the detection of small vessel involvement. Thallium-201, a perfusion agent, is frequently used for the investigation of coronary artery disease, and whole-body (201)Tl scintigraphy (WBS) has also been reported to be useful in the assessment of peripheral artery disease (PAD). Thus, we evaluated the clinical feasibility of simultaneous myocardial and lower limb perfusion assessment. WBS was performed after treadmill exercise and myocardial scintigraphy, and again 4 h later. Calf (201)Tl fractional activities (percentage of whole-body (201)Tl uptake) were calculated. We determined a threshold value of normal post-exercise calf (201)Tl uptake (mean of the (201)Tl fractional uptakes minus 2 SD) in a control group of nine healthy volunteers. We checked its accuracy in a pilot group of 25 diabetic patients with proven PAD. This method permitted the detection of lower limb perfusion abnormalities in 38% of 47 asymptomatic diabetic patients with no evidence of PAD. In conclusion, for asymptomatic diabetic patients, whole-body (201)Tl scintigraphy after a treadmill test seems an efficient method of showing lower limb perfusion abnormalities not detected by ABPI measurement. It allows the evaluation of vascular status with no additional inconvenience for patients when performed after myocardial scintigraphy.