Ankle brachial index importance in early diagnosis and proper management of peripheral artery disease of lower extremity with special reference to diabetes mellitus

Volume 8, Issue 2, April 2024     |     PP. 28-38      |     PDF (198 K)    |     Pub. Date: July 4, 2024
DOI: 10.54647/pm310253    52 Downloads     4873 Views  

Author(s)

Mohey Hulail, Professor of Anatomy, Histology and Embryology, Faculty of medicine, Al-Yarmouk University, Irbid, Jordan.
Diala-Fuad A., M.B.B.ch, General Practice in Irbid , Jordan
Aia-Fuad A., Medical Student in Mutah University in Jordan
Rosol-Fuad A., Medical Student in Zagazig University in Egypt.
Youssef Hussein, Professor, Department of Anatomy, Histology and Embryology, Faculty of medicine, Mutah University, Al- Karak, Jordan

Abstract
- Peripheral artery disease (PAD) of lower extremities is a worldwide healthcare problem. Its prevalence is about 13% in patients over fifty years of age and 29% of people over age of seventy. It affects up to 50% of diabetic patients. This disease is due to partial or total obstruction of one or more the peripheral arteries distal to the aortic arch. It leads to ischemia of the lower extremity that may lead to leg or limb amputations. Also it is a strong predictor of cardiovascular diseases.- It is one of the common complications of type 2 diabetes and has a more aggressive presentation as atherosclerotic plaques tend to be more diffuse in their distribution Early diagnosis of PAD is necessary to allow for early interventions to prevent the functional decline of the lower extremities and to properly manage any associated cardiovascular risk factors. The ankle brachial index (ABI) is the preferred initial screening test for its diagnosis and grading of the obstruction of arteries of lower extremity. ABI is measured by using Doppler ultrasound to obtain the systolic blood pressure of the brachial artery at the right and left arms and that of the dorsalis pedis artery and posterior tibial artery at the right and left ankles. Then the ankle reading is divided by the brachial reading to obtain the ABI measurements. The average normal for adults is ABI values of 0.9 to 1.4. Values lower than 0.9 are indicative of arterial stenosis, and those lower than 0.5 are associated with critical ischemia It is concluded that ABI should be performed for any patient at risk of peripheral artery disease including elderly patients, smokers, diabetics even if they are asymptomatic.

Keywords
Peripheral artery disease, Lower extremity, Ankle-brachial index, diabetes mellitus

Cite this paper
Mohey Hulail, Diala-Fuad A., Aia-Fuad A., Rosol-Fuad A., Youssef Hussein, Ankle brachial index importance in early diagnosis and proper management of peripheral artery disease of lower extremity with special reference to diabetes mellitus , SCIREA Journal of Medicine. Volume 8, Issue 2, April 2024 | PP. 28-38. 10.54647/pm310253

References

[ 1 ] Abouhamda A., Alturkstani M. and Jan Y. (2019): Lower sensitivity of ankle-brachial index measurements among people suffering with diabetes-associated vascular disorders: A systematic review. SAGE Open Medicine. Volume 7: 1– 5
[ 2 ] Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, et al. Measurement and interpretation of the ankle-brachial index. A Scientific Statement From the American Heart Association. Circulation. 2012;126(24): 2890–909.
[ 3 ] Aboyans V, Lacroix P, Doucet S, Preux PM, Criqui MH, Laskar M. Diagnosis of peripheral arterial disease in general practice: can the ankle-brachial index be measured either by pulse palpation or an automatic blood pressure device? Int J Clin Pract. 2008;62.
[ 4 ] Aboyans V, Ricco JB, Bartelink MEL, Bjorck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases. Eur Heart J. 2018;39(9):763–816.
[ 5 ] Aday AW, Matsushita K. Epidemiology of peripheral artery disease and polyvascular disease. Circ Res. 2021;128(12):1818-32. doi: 10.1161/CIRCRESAHA.121.318535.
[ 6 ] Al-Qaisi M, Nott DM, King DH, Kaddoura S. Ankle brachial pressure index (ABPI): an update for practitioners. Vasc Health Risk Manag. 2009;5:833–41.
[ 7 ] Alvaro-Afonso FJ, Garcia-Morales E, Molines-Barroso RJ, Garcia-Alvarez Y, Sanz-Corbalan I, Lazaro-Martinez JL. Interobserver reliability of the anklebrachial index, toe-brachial index and distal pulse palpation in patients with diabetes. Diab Vasc Dis Res. 2018;15(4):344–7.
[ 8 ] Anderson I. The effect of varying cuff position on recording ankle systolic blood pressure. J Wound Care 2002;11(5):185–9.
[ 9 ] Caceres-Farfan L, Moreno-Loaiza M, Cubas WS. Ankle-brachial index: more than a diagnostic test? Arch Peru Cardiol Cir Cardiovasc. 2021;2(4). doi: 10.47487/apcyccv. v2i4.168.
[ 10 ] Carser DG. Do we need to reappraise our method of interpreting the ankle brachial pressure index? J Wound Care 2001;10:59–62.
[ 11 ] Casey S.L., Lanting S.M. and Chuter V.H. (2019): The reliability of the ankle brachial index: a systematic review. Casey et al. Journal of Foot and Ankle Research (2019) 12:39
[ 12 ] Casey S.L., Lanting S.M. and Chuter V.H. (2020): The ankle brachial index in people with and without diabetes: intra-tester reliability. Journal of Foot and Ankle Research (2020) 13:21
[ 13 ] Chesbro SB, Asongwed ET, Brown J, John EB. Reliability of Doppler and stethoscope methods of determining systolic blood pressures: considerations for calculating an ankle-brachial index. J Natl Med Assoc. 2011;103(9):863–9.
[ 14 ] Chevtchouk L, SilvaM.H. and Nascimento O.G.(2017): Ankle-brachial index and diabetic neuropathy: study of 225 patients. Arq Neuropsiquiatr 2017;75(8):533-538
[ 15 ] Chuter VH, Casey SL. Effect of premeasurement rest time on systolic ankle pressure. J Am Heart Assoc. 2013;2(4):e000203.
[ 16 ] Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69(6 Suppl):3S-125S.e40.
[ 17 ] Criqui MH, Langer RD, Fronek A, et al.: Mortality over a period of 10 years in patients with peripheral arterial disease. N Eng J Med 1992; 326: 381-86.
[ 18 ] Criqui MH. Peripheral Arterial Disease- Epidemiological Aspects. Vascular Med 2001; 6(Suppl 1): 3-7.
[ 19 ] Diehm C, Schuster A, Allenberg JR, et al. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 2004; 172: 95-105.
[ 20 ] Dieter RS, Tomasson J, Gudjonsson T, Brown RL, Vitcenda M, Einerson J, et al. Lower extremity peripheral arterial disease in hospitalized patients with coronary artery disease. Vasc Med. 2003;8(4):233-6. doi: 10.1191/1358863x03vm506ra.
[ 21 ] Eid MA, Mehta KS, Goodney PP. Epidemiology of peripheral artery disease. Semin Vasc Surg. 2021;34(1):38-46. doi: 10.1053/j. semvascsurg.2021.02.005.
[ 22 ] Frank, U.; Nikol, S.; Belch, J.; Boc, V.; Brodmann, M.; Carpentier, P.H.; Chraim, A.; Canning, C.; Dimakakos, E.; Gottsater, A.; et al. ESVM Guideline on peripheral arterial disease. Vasa 2019, 48, 1–79. [CrossRef]
[ 23 ] Georgakarakos E, Papadaki E, Vamvakerou V, Lytras D, Tsiokani A, Tsolakaki O, et al. Training to measure ankle–brachial index at the undergraduate level: can it be successful? Int J Low Extrem Wounds. 2013;12(2):167–71.
[ 24 ] Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FG, Hamburg NM, Kinlay S, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12):e726–79.
[ 25 ] Gornik HL, Creager MA. Contemporary management of peripheral arterial disease: I. cardiovascular risk-factor modification. Cleve Clin J Med 2006; 73(suppl 4):S30–S37
[ 26 ] Haigh K, Bingley J, Golledge J, Walker P. Peripheral arterial disease-screening in general practice. Aust Fam Physician. 2013;42:391–5.
[ 27 ] Hiatt WR . Medical Treatment of peripheral arterial disease and claudication. N Eng J Med 2001; 344: 1608-21.
[ 28 ] Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care. JAMA. 2001;286(11):1317-24. doi: 10.1001/jama.286.11.1317.
[ 29 ] Ichihashi S, Desormais I, Hashimoto T, Magne J, Kichikawa K, Aboyans V. Accuracy and Reliability of the Ankle Brachial Index Measurement Using a Multicuff Oscillometric Device Versus the Doppler Method. Eur J Vasc Endovasc Surg. 2020;60(3):462-8. doi: 10.1016/j.ejvs.2020.06.013.
[ 30 ] Jelinek H.F., Austin M. (2006): The ankle–brachial index in clinical decision making The Foot 16 (2006) 153–157
[ 31 ] Khan T. H., Farooqui F.A. and Niazi K. (2008): Critical Review of the Ankle Brachial IndexCurrent Cardiology Reviews, 2008, 4, 101-106
[ 32 ] Kim E.S.H., Wattanakit K., Peoria, IL and Gornik H.L. (2012): Using the ankle-brachial index to diagnose peripheral artery disease and assess cardiovascular risk. Cleveland Clinic Journal of Medicine. Volume 79 Number 9
[ 33 ] Li Y. H, Sheu W.H. and Lee I. T. (2020): Use of the ankle‑brachial index combined with the percentage of mean arterial pressure at the ankle to improve prediction of all‑cause mortality in type 2 diabetes mellitus: an observational study Li et al. Cardiovasc Diabetol (2020) 19:173 https://doi.org/10.1186/s12933-020-01149-7
[ 34 ] Marso SP, Hiatt WR . Peripheral Arterial Disease in Patients withDiabetes. J Am Coll Cardiol 2006; 47: 921-29.
[ 35 ] Maruhashi T, Kajikawa M, Kishimoto S, Hashimoto H, Takaeko Y, Yamaji T, et al. Upstroke Time Is a Useful Vascular Marker for Detecting Patients With Coronary Artery Disease Among Subjects With Normal Ankle‐Brachial Index. J Am Heart Assoc Cardiovasc Cerebrovasc Dis. 2020;9(23):e017139. doi: 10.1161/JAHA.120.017139.
[ 36 ] McClary KN, Massey P. Ankle Brachial Index. En: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021
[ 37 ] McDermot 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 Vasc Surg 2000; 32: 1164-71.
[ 38 ] McDermott MM, Ferruci L, Simonsick EM, et al. The ankle brachial index and change in lower extremity functioning over time: the Women’s Health and Aging Study. J Am Geriatr Soc 2002; 50: 238-46.
[ 39 ] McDermott MM, Greenland P, Liu K, et al. Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA 2001; 286:1599–1606.
[ 40 ] Murabito JM, Evans JC, Larson MG, Nieto K, Levy D, Wilson PW. Framingham Study. The ankle-brachial index in the elderly and risk of stroke, coronary disease and death. Arch Intern Med 2003; 63: 1939-42
[ 41 ] Natsuaki C, Inoguchi T., Maeda Y, Yamada T, Sasaki S, Sonoda N, Shimabukuro M, Nawata H, Takayanagi R (2014): Association of borderline ankle-brachial index with mortality and the incidence of peripheral artery disease in diabetic patients. Atherosclerosis 234 (2014) 360 - 365
[ 42 ] Nicolai SP, Kruidenier LM, Rouwet EV, Bartelink ML, Prins MH, Teijink JA. Ankle brachial index measurement in primary care: are we doing it right? Br J Gen Pract. 2009;59(563):422–7.
[ 43 ] Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR. Intersociety consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(1):S5–S67.
[ 44 ] Pilli R, Naidu M, Pingali U, Takallapally RK. Study of cardiovascular effects of caffeine in healthy human subjects, with special reference to pulse wave velocity using photoplethy-smography. Int J Nutr Pharmacol Neurol Dis. 2012;2(3):243–50.
[ 45 ] Reinecke, H.; Unrath, M.; Freisinger, E.; Bunzemeier, H.; Meyborg, M.; Luders, F.; Gebauer, K.; Roeder, N.; Berger, K.; Malyar, N.M. Peripheral arterial disease and critical limb ischaemia: Still poor outcomes and lack of guideline adherence. Eur. Heart J. 2015, 36, 932–938. [CrossRef] [PubMed]
[ 46 ] Rodway, A.D.; Cheal, D.; Allan, C.; Pazos-Casal, F.; Hanna, L.; Field, B.C.T.; Pankhania, A.; Aston, P.J.; Skene, S.S.; Maytham, G.D.; et al. Ankle Doppler for Cuffless Ankle Brachial Index Estimation and Peripheral Artery Disease Diagnosis Independent of Diabetes. J. Clin. Med. 2023, 12, 97. https://doi.org/ 10.3390/jcm12010097
[ 47 ] Rosenbaum D, Rodriguez-Carranza S, Laroche P, Bruckert E, Giral P, Girerd X. Accuracy of the ankle-brachial index using the SCVL(®), an arm and ankle automated device with synchronized cuffs, in a population with increased cardiovascular risk. Vasc Health Risk Manag. 2012;8:239–46.
[ 48 ] Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation 2004; 110:738–743.
[ 49 ] Sonter JA, Chuter V, Casey S. Intratester and intertester reliability of toe pressure measurements in people with and without diabetes performed by podiatric physicians. J Am Podiatr Med Assoc. 2015;105(3):201–8.
[ 50 ] Špan M, Geršak G, Millasseau SC, Meža M, Košir A. Detection of peripheral arterial disease with an improved automated device: comparison of a new oscillometric device and the standard Doppler method. Vasc Health Risk Manag. 2016;12:305–11.
[ 51 ] Stoberock, K.; Kaschwich, M.; Nicolay, S.S.; Mahmoud, N.; Heidemann, F.; Rieß, H.C.; Debus, E.S.; Behrendt, C.-A. The interrelationship between diabetes mellitus and peripheral arterial disease—A systematic review. Vasa 2021, 50, 323–330. [CrossRef] [PubMed]
[ 52 ] Thurston B, Dawson J. Ankle Brachial Pressure Index: An update for the vascular specialist and general practitioner. Vascular. 2019;27(5):560-70. doi: 10.1177/1708538119842395.
[ 53 ] Vogt MT, Mckenna M, Anderson SJ, Wolfson SK, Kuller LH. The relationship between ankle-arm index and mortality in older men and women. J Am Geriatr Soc 1993; 41: 523-30.
[ 54 ] Vowden P, Vowden K. Doppler assessment and ABPI: interpretation in the management of leg ulceration. World Wide Wounds, Accessed 7 Dec 2005, www.worldwidewounds.com.
[ 55 ] Waring WS, Goudsmit J, Marwick J, Webb DJ, Maxwell SR. Acute caffeine intake influences central more than peripheral blood pressure in young adults. Am J Hypertens. 2003;16(11 Pt 1):919–24.
[ 56 ] Weitz JI, Byrne J, Clagett GP, et al. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: A critical review. Circulation 1996; 94: 3026-49.
[ 57 ] Wilkinson IB, Hall IR, MacCallum H, Mackenzie IS, McEniery CM, van der Arend BJ, et al. Pulse-Wave Analysis: clinical evaluation of a noninvasive, widely applicable method for assessing endothelial function. Arterioscler Thromb Vasc Biol 2002;22: 147–52.