Document Detail


Limitation of the resting ankle-brachial index in symptomatic patients with peripheral arterial disease.
MedLine Citation:
PMID:  16669410     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Peripheral arterial disease (PAD) has been demonstrated to be prevalent in the primary care setting. However, it has also been shown to be unrecognized and under-treated. Owing to the association with cardiovascular disease it has been recommended to screen high-risk patients for PAD in the primary care setting using the ankle-brachial index (ABI). ABI has been demonstrated to be highly sensitive and specific in diagnosing PAD in patients with significant stenosis. However, the utility in patients with less severe stenosis and calcified vessels is in question. The aims of this study were to determine the diagnostic utility of measuring the ABI at rest in patients referred to the vascular laboratory for evaluation of suspected PAD, and to assess the added value of pulse volume recordings and post-exercise studies in patients with a normal ABI. A computerized vascular diagnostic laboratory database was queried for symptomatic outpatients referred for measurement of segmental blood pressure, the ABI or pulse volume recordings by physicians not specialized in the evaluation and management of patients with peripheral vascular disease. Of 707 patients undergoing outpatient physiologic arterial evaluations between February 1, 2003 and July 31, 2004, 396 met these inclusion criteria. Data recorded included resting ABI, ABI following treadmill exercise test and the presence of abnormal pulse volume recordings. The study population (n = 396) consisted of equal numbers of men and women (mean age 69 years, range 19-100 years). Among 396 studies, resting ABI values were normal in 183 (46.2%) and abnormal in 159 (40.2%). Of the 138 patients who underwent exercise testing, 84 had normal ABI readings at rest. In the 84 patients who had a normal ABI at rest and underwent exercise testing, the ABI fell below 0.9 after exercise in 26 (31%). Arterial non-compressibility was detected in 54 (13.6%) patients, whose average age was 67 years. Thirteen (24%) of those with non-compressible vessels had abnormal pulse volume recording (PVR) results, compared to five with normal resting ABI who had abnormal PVR findings (2.7%). In conclusion, this study demonstrated that nearly half of patients referred to the outpatient vascular laboratory because of suspected arterial disease had a normal resting ABI. While it is recommended that the ABI be measured at rest in patients at risk of PAD in primary care practice, these findings suggest that patients with symptoms of PAD should be more completely evaluated in a vascular laboratory. Furthermore, when the ABI is normal at rest in patients with symptoms of intermittent claudication, exercise testing is recommended to enhance the sensitivity for detection of PAD.
Authors:
Russell Stein; Ingrid Hriljac; Jonathan L Halperin; Susan M Gustavson; Victoria Teodorescu; Jeffrey W Olin
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Vascular medicine (London, England)     Volume:  11     ISSN:  1358-863X     ISO Abbreviation:  Vasc Med     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-05-03     Completed Date:  2006-08-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9610930     Medline TA:  Vasc Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  29-33     Citation Subset:  IM    
Affiliation:
Zena and Michael A Wiener Cardiovascular Institute, Marie-Josée and Henry R Kravis Center for Cardiovascular Health, Mount Sinai Medical Center, New York, NY 10029, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Ambulatory Care*
Ankle / blood supply*
Arterial Occlusive Diseases / diagnosis*,  physiopathology,  ultrasonography
Blood Pressure*
Brachial Artery / physiopathology*,  ultrasonography
Elasticity
Exercise Test
Female
Humans
Male
Mass Screening* / methods
Middle Aged
Peripheral Vascular Diseases / diagnosis*,  physiopathology,  ultrasonography
Practice Guidelines as Topic
Predictive Value of Tests
Primary Health Care*
Pulse
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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