Ankle brachial index

0 Comments | Saturday Evening Post, Nov-Dec, 2007

Peripheral arterial disease (PAD) is closely associated with heart attack or stroke. Recently, German scientists found that the ankle brachial index (ABI), a simple test performed by measuring blood pressure at the ankle to diagnose PAD, could help identify atherosclerosis at an early stage and predict what risk such patients carry in the future. Professor Curt Diehm from the Clinic Karlsbad-Langensteinbach in Heidelberg and coworkers from various medical institutions in Germany presented a 5-year study follow-up.

"We used the ankle brachial index (ABI), which is simple to understand and to apply by physicians and nurses," explained Professor Diehm. "In an individual in the supine position, the blood pressure in the leg arteries is equal to or a little higher than in the arm arteries. If atherosclerotic stenoses [narrowing of the arteries] in the legs manifests (termed PAD), blood flow after the obstruction decreases, and the pressure in the leg artery is lower than in the arm. This sign is almost as reliable as angiography to identify your atherosclerotic risk patient."

The study included 6,880 unselect ed patients, who underwent ABI testing by their primary care physician. Even when all other known risk factors for cardiovascular death were accounted for by statistical means, PAD had the best ability to predict future death, stroke or myocardial infarction.

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"The good news is that the ABI test is not limited to expert use but can be performed in general practice," said Professor Diehm, who suggested that ABI screening become standard practice for elderly patients and patients with risk factors such as diabetes or hypertension. "Thus, family physicians can identify high-risk patients and initiate and maintain effective treatment in this large group. A huge number of lives could be saved if patients with atherosclerosis would be identified with the ABI, and treated timely."