Ankle-brachial index

Peripheral arterial disease (claudication or ankle-brachial index less than 0.9)... 

Exts Ankle-brachial index 1.1 Neck No carotid and basilar bruits... 

Two studies evaluated the effects of lipid-lowering therapy on clinical endpoints in the leg. The Program on the Surgical Control of the Hyperlipidemias was a randomized trial of partial ileal-bypass surgery for the treatment of hyperlipidemia in 838 patients (9). After five years, the relative risk (RR) of an abnormal ankle-brachial index value (ABI) was 0.6 (95% Cl, 0.4 to 0.9, absolute risk reduction, 15% points, p < 0.01), and the RR of claudication or limb-threatening ischemia was 0.7 (95% Cl, 0.2 to 0.9, absolute risk reduction, 7% points, p < 0.01), as compared with the control group. 

Lange S, Trampisch HJ, Haberl R, et al. Excess I-year cardiovascular risk in elderly primary care patients with a low ankle-brachial index (ABI) and high homocysteine level. Atherosclerosis 2005 178(2) 351 -357. 

A 41-year-old woman presented with pain and pallor in the leg and a sensation of coolness exacerbated by exercise (34). For many years she had been taking a formulation containing ergotamine 1 mg plus caffeine 100 mg, at a dose of one or two tablets daily, for both prophylaxis and treatment of migraine. For 7 days she had also taken clarithromycin (dose is not stated) for a chest infection. Her legs were cool and cyanosed, with no palpable popliteal or foot pulses and an ankle-brachial index of only 0.6 (normal >0.8). 

ABI, ankle-brachial index CCS, Canadian Cardiovascular Society DB, double-blind ETT, exercise tolerance test ia, intra-arterial ic, intracoronary iv, intravenous MRI, magnetic resonance imaging SAQ, Seattle Angina Questionnaire SPECT, single photon... 

The ankle-brachial index (ABI) is a simple, noninvasive, quantitative test that has been proven to be a highly sensitive and specific tool in the diagnosis of peripheral arterial disease. 

McDermott MM, Greenland P, Liu K, et al. The ankle brachial index is associated with leg function and physical activity the Walking and Leg Circulation Smdy. Ann Int Med 2002 136 873-883. 

McDermott MM, Criqui MH, Liu K, et al. Lower ankle/brachial index, as calculated by averaging the dorsalis pedis and posterior tibial arterial pressures, and association with leg functioning in peripheral arterial disease. J Vase Surg 2000 32 1164-1171. 

Baumgartner 1998 Critical lower extremity ischemia Critical ischemia, resistant to maximal medical therapy, not surgical candidates Naked plasmid VEGF 165 Intramuscular injection Phase I 2-11 months Improved Ankle-Brachial index, exercise time, new vessels on angiogram, limb salvage, improved tissue integrity... 

Clearly, diabetics who have peripheral arterial disease have higher mortality rates than those who do not have arterial disease. A recent study by Vogt et al. (15) evaluated the relationship between peripheral arterial disease and mortality in a population of close to 2000 individuals over a 13-year period. All patients 50 years of age and older with no history of lower extremity surgery were evaluated for the presence of peripheral arterial disease. Analysis of the data stratified by populations and comorbid conditions showed that a low ankle-brachial index is an independent predictor of all causes of mortality in both men and women with peripheral arterial disease. This increase is a relative risk and is unchanged after exclusions of all patients with a clinical history of cardiovascular disease or diabetes. Thus, a low ankle-brachial index is an important measurement to obtain to assess the risk of mortality among those who smoke and have either angina or diabetes. 

Risk Factors of LEAD Co-Existing With Coronary Artery Disease Other Than Over 40 Years of Age What Do Patients With Lower Extremity Arterial Disease Assessed With a Low Ankle-Brachial Index Die From Dobutamine Stress Echocardiography Management... 

WHAT DO PATIENTS WITH LOWER EXTREMITY ARTERIAL DISEASE ASSESSED WITH A LOW ANKLE-BRACHIAL INDEX DIE FROM ... 

McDermott MM, Mehta S, Liuk, et al. Legs symptoms, the ankle-brachial index, and walking ability in patients with peripheral arterial disease. J Gen Internal Med 1999 14 173-181. 

In treating limb-threatening ischemia, sympathectomy has a limited role because arterial construction is more reliable and yields a far greater chance of limb salvage. Patients who are candidates for sympathectomy are truly nonreconstructible and have at least some inflow (as manifested by an ankle-brachial index greater than 0.30), no evidence of neuropathy, and limited tissue loss. Response to preoperative chemical sympathetic blockade may predict success for operative sympathectomy. In carefully selected patients, sympathectomy may provide the small increase in limb perfusion needed to tip the scales in the direction of ulcer healing and resolution of rest pain. 

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