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Role of the Ankle Brachial Index

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Imaging in Peripheral Arterial Disease

Abstract

Lower extremity peripheral artery disease (PAD) affects 8.5 million men and women in the United States and more than 200 million people worldwide. People with PAD have a two- to threefold increased rate of cardiovascular events and all-cause mortality compared to people without PAD. People with PAD also have greater functional impairment and faster functional decline than people without PAD. The ankle brachial index (ABI) is a reliable, sensitive, and highly specific noninvasive test for PAD and can be used to diagnose and assess the severity of PAD. This chapter provides an overview of the role of the ABI in diagnosing PAD and in assessing risk of cardiovascular outcomes, lower extremity outcomes, and functional decline.

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References

  1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e146–603. PMCID: PMC5408160.

    Article  Google Scholar 

  2. Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, Norman PE, Sampson UK, Williams LJ, Mensah GA, Criqui MH. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329–40.

    Article  Google Scholar 

  3. Ankle Brachial Index Collaboration, Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, Chambless LE, Folsom AR, Hirsch AT, Dramaix M, de Backer G, Wautrecht JC, Kornitzer M, Newman AB, Cushman M, Sutton-Tyrrell K, Fowkes FG, Lee AJ, Price JF, d’Agostino RB, Murabito JM, Norman PE, Jamrozik K, Curb JD, Masaki KH, Rodríguez BL, Dekker JM, Bouter LM, Heine RJ, Nijpels G, Stehouwer CD, Ferrucci L, McDermott MM, Stoffers HE, Hooi JD, Knottnerus JA, Ogren M, Hedblad B, Witteman JC, Breteler MM, Hunink MG, Hofman A, Criqui MH, Langer RD, Fronek A, Hiatt WR, Hamman R, Resnick HE, Guralnik J, McDermott MM. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008;300(2):197–208. PMCID: PMC2932628.

    Article  Google Scholar 

  4. Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015;116(9):1509–26.

    Article  CAS  Google Scholar 

  5. McDermott MM, Greenland P, Liu K, Guralnik JM, Celic L, Criqui MH, Chan C, Martin GJ, Schneider J, Pearce WH, Taylor LM, Clark E. The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med. 2002;136(12):873–83.

    Article  Google Scholar 

  6. McDermott MM, Liu K, Greenland P, Guralnik JM, Criqui MH, Chan C, Pearce WH, Schneider JR, Ferrucci L, Celic L, Taylor LM, Vonesh E, Martin GJ, Clark E. Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms. JAMA. 2004;292(4):453–61.

    Article  CAS  Google Scholar 

  7. McDermott MM, Guralnik JM, Tian L, Liu K, Ferrucci L, Liao Y, Sharma L, Criqui MH. Associations of borderline and low normal ankle-brachial index values with functional decline at 5-year follow-up: the WALCS (The Walking and Leg Circulation Study). J Am Coll Cardiol. 2009;53(12):1056–62. PMCID: PMC3215766.

    Article  Google Scholar 

  8. McDermott MM, Ferrucci L, Liu K, Guralnik JM, Tian L, Liao Y, Criqui MH. Leg symptom categories and rates of mobility decline in peripheral artery disease. J Am Geriatr Soc. 2010;58(7):1256–62. PMCID: PMC3227868.

    Article  Google Scholar 

  9. McDermott MM, Fried L, Simonsick E, Ling S, Guralnik JM. Asymptomatic peripheral arterial disease is independently associated with impaired lower extremity functioning: the women’s health and aging study. Circulation. 2000;101(9):1007–12.

    Article  CAS  Google Scholar 

  10. McDermott MM, Greenland P, Liu K, Guralnik JM, Criqui MH, Dolan NC, Chan C, Celic L, Pearce WH, Schneider JR, Sharma L, Clark E, Gibson D, Martin GJ. Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA. 2001;286(13):1599–606.

    Article  CAS  Google Scholar 

  11. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME, Halperin JL. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12):e686–725. PMCID: PMC5479414.

    PubMed  Google Scholar 

  12. McDermott MM, Ferrucci L, Tian L, Guralnik JM, Lloyd-Jones D, Kibbe MR, Polonsky TS, Domanchuk K, Stein JH, Zhao L, Taylor D, Skelly C, Pearce W, Perlman H, McCarthy W, Li L, Gao Y, Sufit R, Bloomfield CL, Criqui MH. Effect of granulocyte-macrophage colony-stimulating factor with or without supervised exercise on walking performance in patients with peripheral artery disease. JAMA. 2017;318(21):2089–98. PMCID: PMC5820720.

    Article  CAS  Google Scholar 

  13. McDermott MM. Exercise rehabilitation for peripheral artery disease: a review. J Cardiopulm Rehabil Prev. 2018;38(2):63–9. PMCID: PMC5831500.

    Article  Google Scholar 

  14. Rose GA. The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ. 1962;27(6):645–58. PMCID: PMC2555832.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. McDermott MM. Lower extremity manifestations of peripheral artery disease: the pathophysiologic and functional implications of leg ischemia. Circ Res. 2015;116(9):1540–50. PMCID: PMC4410164.

    Article  Google Scholar 

  16. Newman AB, Naydeck BL, Sutton-Tyrrell K, Polak JF, Kuller LH, Cardiovascular Health Study Research Group. The role of comorbidity in the assessment of intermittent claudication in older adults. J Clin Epidemiol. 2001;54(3):294–300.

    Article  CAS  Google Scholar 

  17. Criqui MH, Fronek A, Klauber MR, Barrett-Connor E, Gabriel S. The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. Circulation. 1985;71(3):516–22.

    Article  CAS  Google Scholar 

  18. McDermott MM, Guralnik JM, Ferrucci L, Tian L, Liu K, Liao Y, Green D, Sufit R, Hoff F, Nishida T, Sharma L, Pearce WH, Schneider JR, Criqui MH. Asymptomatic peripheral arterial disease is associated with more adverse lower extremity characteristics than intermittent claudication. Circulation. 2008;117(19):2484–91. PMCID:PMC5077147.

    Article  Google Scholar 

  19. Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, Fowkes FG, Hiatt WR, Jönsson B, Lacroix P, Marin B, McDermott MM, Norgren L, Pande RL, Preux PM, Stoffers HE, Treat-Jacobson D, American Heart Association Council on Peripheral Vascular Disease, Council on Epidemiology and Prevention, Council on Clinical Cardiology, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012;126(24):2890–909.

    Article  Google Scholar 

  20. Lijmer JG, Hunink MGM, van den Dungen JL, Smit AJ. ROC analyses of noninvasive tests for peripheral arterial disease. Ultrasound Med Biol. 1996;22(4):391–8.

    Article  CAS  Google Scholar 

  21. Guo X, Li J, Paang W, Zhao M, Luo Y, Sun Y, Hu D. Sensitivity and specificity of ankle-brachial index for detecting angiographic stenosis of peripheral arteries. Circ J. 2008;72(4):605–10.

    Article  Google Scholar 

  22. Ouriel K, McDonnell AE, Metz CE, Zarinss CK. Critical evaluation of stress testing in the diagnosis of peripheral vascular disease. Surgery. 1982;91(6):686–93.

    CAS  PubMed  Google Scholar 

  23. McDermott MM, Criqui MH, Liu K, Guralnik JM, Greenland P, Martin GJ, Pearce W. Lower ankle/brachial index, as calculated by averaging the dorsalis pedis and posterior tibial pressure, and lower extremity functioning in peripheral arterial disease. J Vasc Surg. 2000;32(6):1164–71.

    Article  CAS  Google Scholar 

  24. Nead KT, Cooke JP, Olin JW, Leeper NJ. Alternative ankle-brachial index method identifies additional at-risk individuals. J Am Coll Cardiol. 2013;62(6):553–9. PMCID:PMC3732795.

    Article  Google Scholar 

  25. Hamalainen H, Ronnemaa T, Halonen JP, Toikka T. Factors predicting lower extremity amputation in patients with type 1 or type 2 diabetes mellitus: a population based 7-year follow-up study. J Intern Med. 1999;246(1):97–103.

    Article  CAS  Google Scholar 

  26. Marston WA, Davies SW, Armstrong B, Farber MA, Mendes RC, Fulton JJ, Keagy BA. Natural history of limbs with arterial insufficiency and chronic ulceration treated without revascularization. J Vasc Surg. 2006;44(1):108–14.

    Article  Google Scholar 

  27. Tehan PE, Bray A, Chuter VH. Non-invasive vascular assessment in the foot with diabetes: sensitivity and specificity of the ankle brachial index, toe brachial index and continuous wave Doppler for detecting peripheral arterial disease. J Diabetes Complicat. 2016;30(1):155–60.

    Article  Google Scholar 

  28. Brownrigg JR, Hinchliffe RJ, Apelqvist J, Boyko EJ, Fitridge R, Mills JL, Reekers J, Shearman CP, Zierler RE, Schaper NC, International Working Group on the Diabetic Foot. Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: a systematic review. Diabetes Metab Res Rev. 2016;32:119–27.

    Article  CAS  Google Scholar 

  29. Tehan PE, Barwick AL, Sebastian M, Chuter VH. Diagnostic accuracy of the postexercise ankle-brachial index for detecting peripheral artery disease in suspected claudicants with and without diabetes. Vasc Med. 2018;23(2):116–25.

    Article  Google Scholar 

  30. McPhail IR, Spittel PC, Weston SA, Bailey KR. Intermittent claudication: an objective office-based assessment. J Am Coll Cardiol. 2001;37(5):1381–5.

    Article  CAS  Google Scholar 

  31. Amirhamzeh MM, Chant HJ, Rees JL, Hands LJ, Powell RJ. Campbell WB.A comparative study of treadmill tests and heel raising exercise for peripheral arterial disease. Eur J Vasc Endovasc Surg. 1997;13(3):301–5.

    Article  CAS  Google Scholar 

  32. Hoogeveen EK, Mackaay AJ, Beks PJ, Kostense PJ, Dekker JM, Heine RJ, Nijpels G, Rauwerda JA, Stehouwer CD. Evaluation of the one-minute exercise test to detect peripheral arterial disease. Eur J Clin Investig. 2008;38(5):290–5.

    Article  CAS  Google Scholar 

  33. McLafferty RB, Moneta GL, Taylor LM Jr, Porter JM. Ability of ankle-brachial index to detect lower extremity atherosclerotic disease progression. Arch Surg. 1997;132(8):836–41.

    Article  CAS  Google Scholar 

  34. Nicoloff AD, Taylor LM Jr, Sexton GJ, Schuff RA, Edwards JM, Yeager RA, Landry GJ, Moneta GL, Porter JM, Homocysteine and Progression of Atherosclerosis Study Investigators. Homocysteine and progression of atherosclerosis study investigators: relationship between site of initial symptoms and subsequent progression of disease in a prospective study of atherosclerosis progression in patients receiving long-term treatment for symptomatic peripheral arterial disease. J Vasc Surg. 2002;35(1):38–46.

    PubMed  Google Scholar 

  35. Cronenwett JL, Warner KG, Zelencock GB, Whitehouse WM Jr, Graham LM, Lindenauer SM, Stanley JC. Intermittent claudication: current results of nonoperative management. Arch Surg. 1984;119(4):430–6.

    Article  CAS  Google Scholar 

  36. Newman AB, Shemanski L, Manolio TA, Cushman M, Mittelmark M, Polak JF, Powe NR, Siscovick D. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardiovascular Health Study Group. Arterioscler Thromb Vasc Biol. 1999;19(3):538–45.

    Article  CAS  Google Scholar 

  37. Abbott RD, Petrovitch H, Rodriguez BL, Yano K, Schatz IJ, Popper JS, Masaki KH, Ross GW, Curb JD. Ankle/brachial blood pressure in men > 70 years of age and the risk of coronary heart disease. Am J Cardiol. 2000;86(3):280–4.

    Article  CAS  Google Scholar 

  38. Resnick HE, Lindsay RS, McDermott MM, Devereux RB, Jones KL, Fabsitz RR, Howard BV. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation. 2004;109(6):733–9.

    Article  Google Scholar 

  39. Leng GC, Fowkes FG, Lee AJ, Dunbar J, Housley E, Ruckley CV. Use of the ankle brachial pressure index to predict cardiovascular events and death: a cohort study. BMJ. 1996;313(7070):1440–4. PMCID: PMC2352992.

    Article  CAS  Google Scholar 

  40. Hooi JD, Kester AD, Stoffers HE, Rinkens PE, Knottnerus JA, van Ree JW. Asymptomatic peripheral arterial occlusive disease predicted cardiovascular morbidity and mortality in a 7-year follow-up study. J Clin Epidemiol. 2004;57(3):294–300.

    Article  CAS  Google Scholar 

  41. McDermott MM, Liu K, Criqui MH, Ruth K, Goff D, Saaad MF, Wu C, Homma S, Sharrett R. Ankle-brachial index and subclinical cardiac and carotid disease. The multi-ethnic study of atherosclerosis. Am J Epidemiol. 2005;162(1):33–41.

    Article  Google Scholar 

  42. Aboyans V, Criqui MH, McClelland RL, Allison MA, McDermott MM, Goff DC, Manolio TA. Intrinsic contribution of gender and ethnicity to normal ankle-brachial index values: The Multi-Ethnic Study of Atherosclerosis. J Vasc Surg. 2007;45(2):319–27.

    Article  Google Scholar 

  43. Kapoor R, Ayers C, Visotcky A, Mason P, Kulinski J. Association of sex and height with a lower ankle brachial index in the general population. Vasc Med. 2018;23(6):534–40.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Mary M. McDermott

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  1. Mary M. McDermott
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Correspondence to Mary M. McDermott .

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Editors and Affiliations

  1. Departments of Medicine and Radiology, University of Virginia, Charlottesville, VA, USA

    Christopher M. Kramer

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McDermott, M.M. (2020). Role of the Ankle Brachial Index. In: Kramer, C. (eds) Imaging in Peripheral Arterial Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-24596-2_2

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  • DOI: https://doi.org/10.1007/978-3-030-24596-2_2

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  • Online ISBN: 978-3-030-24596-2

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