Ankle-Brachial Index Should Be Measured in Both the Posterior and the Anterior Tibial Arteries in Studies of Peripheral Arterial Disease

Abstract

Lower extremity peripheral artery disease (PAD) is a powerful predictor of cardiovascular events and mortality. The ankle-brachial index (ABI) is an objective and standard diagnostic method to diagnose PAD (an ABI ≤ 0.9 is considered pathological). The American Heart Association (AHA) and the American College of Cardiology (ACC) recommend using both the posterior and anterior tibial arteries when assessing ABI. We investigated whether there was a difference in the diagnosis of PAD if the ABI was measured in the posterior or the anterior tibial arteries. The results showed that among participants with ABI ≤0.9, between 30% and 40% would not get a PAD diagnosis if the ABI was measured in only 1 of the arteries. In conclusion, this study emphasizes the importance of measuring the ABI in both the posterior tibial and the anterior tibial arteries when diagnosing PAD.

Keywords

ankle-brachial index posterior tibial artery anterior tibial artery peripheral arterial disease

Get full access to this article

View all access options for this article.

References

Faxon DP , Creager MA , Smith SC Jr , et al. Atherosclerotic Vascular Disease Conference: Executive summary: Atherosclerotic Vascular Disease Conference proceeding for healthcare professionals from a special writing group of the American Heart Association. Circulation. 2004;109(21):2595-2604.

Makaryus A. Cardiovascular imaging for the assessment of atherosclerotic disease: implications for cardiac risk stratifications. Curr Cardiovasc Risk Rep . 2008;3(2):107-112.

Allaqaband SKR , Jan F. , Bajawa T. Endovascular treatment of peripheral vascular disease. Curr Probl Cardiol. 2009;34(9): 359-476.

Criqui MH , Fronek A. , Barrett-Connor E. , Klauber MR , Gabriel S. , Goodman D. The prevalence of peripheral arterial disease in a defined population . Circulation. 1985;71(3):510-515.

Becker GJ , McClenny TE , Kovacs ME , Raabe RD , Katzen BT The importance of increasing public and physician awareness of peripheral arterial disease. J Vasc Interv Radiol. 2002 ;13(1):7-11.

Golomb BA , Dang TT , Criqui MH Peripheral arterial disease: morbidity and mortality implications . Circulation. 2006;114(7): 688-699.

Lamina C. , Meisinger C. , Heid IM , et al. Association of ankle-brachial index and plaques in the carotid and femoral arteries with cardiovascular events and total mortality in a population-based study with 13 years of follow-up. Eur Heart J. 2006;27(21): 2580-2587.

Mohler ER 3rd , Treat-Jacobson D. , Reilly MP , et al. Utility and barriers to performance of the ankle-brachial index in primary care practice . Vasc Med. 2004;9(4):253-260.

Schroder F. , Diehm N. , Kareem S. , et al. A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease. J Vasc Surg. 2006;44(3):531-536.

10.

Gornik HL , Garcia B. , Wolski K. , Jones DC , Macdonald KA , Fronek A. Validation of a method for determination of the ankle-brachial index in the seated position. J Vasc Surg. 2008; 48(5):1204-1210.

11.

Resnick HE , Lindsay RS , McDermott MM , et al. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation. 2004; 109(6):733-739.

12.

Hirsch AT , Haskal ZJ , Hertzer NR , et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006;113(11):e463-e654.

13.

Leng GC , Fowkes FG , Lee AJ , Dunbar J. , Housley E. , Ruckley CV Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study. BMJ. 1996;313(7070):1440-1444.

14.

Smith FB , Lee AJ , Price JF , van Wijk MC , Fowkes FG Changes in ankle brachial index in symptomatic and asymptomatic subjects in the general population. J Vasc Surg. 2003 ;38(6):1323-1330.

15.

Bokemark L. , Wikstrand J. , Wedel H. , Fagerberg B.

Insulin, insulin propeptides and intima-media thickness in the carotid artery in 58-year-old clinically healthy men. The Atherosclerosis and Insulin Resistance study (AIR)

Diabet Med . 2002;19(2):144-151.

16.

Behre CJ , Brohall G. , Hulthe J. , Fagerberg B. Serum adiponectin in a population sample of 64-year-old women in relation to glucose tolerance, family history of diabetes, autoimmunity, insulin sensitivity, C-peptide, and inflammation. Metabolism. 2006 ; 55(2):188-194.

17.

Murabito JM , Evans JC , Nieto K. , Larson MG , Levy D. , Wilson PW Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study. Am Heart J. 2002; 143(6):961-965.

18.

Tivesten A. , Mellstrom D. , Jutberger H. , et al. Low serum testosterone and high serum estradiol associate with lower extremity peripheral arterial disease in elderly men. The MrOS Study in Sweden. J Am Coll Cardiol. 2007;50(11):1070-1076.

19.

Lange SF , Trampisch HJ , Pittrow D. , et al. Profound influence of different methods for determination of the ankle brachial index on the prevalence estimate of peripheral arterial disease. BMC Public Health. 2007;7:147.

20.

Gornik HL , Beckman JA Cardiology patient page. Peripheral arterial disease. Circulation . 2005;111(13):e169-172.

21.

Wikstrom J. , Hansen T. , Johansson L. , Ahlstrom H. , Lind L. Lower extremity artery stenosis distribution in an unselected elderly population and its relation to a reduced ankle-brachial index. J Vasc Surg. 2009;50(2):330-334.