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L.R. Antony Soundararajan1, S. Mannickal Thankappan2, Q. T Alshammari3, A. Jopran Moashi4
1University of Hail, Physical Therapy, Hail, Saudi Arabia, 2University of Hail, Anatomy, Hail, Saudi Arabia, 3University of Hail, Saudi Arabia, Department of Diagnostic Radiology, Ha'il, Saudi Arabia, 4Jazan General Hospital, Physical Therapy, Jazan, Saudi Arabia
Background: Peripheral arterial disease (PAD) in lower extremities is increasing with age in the population with prevalence of 13% in the over 50 age group. Ankle brachial index (ABI) is a reliable noninvasive method for assessment of the severity of lower limb ischemia. Current guidelines for screening and management of PAD in primary health care advise to measure ABI in all subjects especially in patients more than 65 years, in patients more than 50 years if they have hypertension, diabetes, and/or are currently smokers and in subjects with clinical symptoms of PAD. Though ABI obtained by Doppler method is usually regarded as the gold standard, there are some drawbacks of this like it requires an experienced operator, is time-consuming and not available in the primary care.
Purpose: In primary health care settings measurement of ABI by Doppler is not done strictly because of the unavailability of the equipment, lack of training to the health professionals, technique is cumbersome and time consuming. Thus, in this study, we evaluated the diagnostic accuracy and reproducibility of ABI measured with the simple automatic pressure monitor [ABI-APM], which is easily available and inexpensive in primary care over the gold standard ABI measurement by Hand-Held Doppler [ABI-HHD].
Methods: 108 subjects above 50 years of age who fulfills the criteria of PAD screening guideline were selected and divided into 3 groups namely normal (n=32), patients with presence of risk factor (n=21) and patients with PAD (=55). ABI-HHD was calculated by dividing the highest systolic blood pressure from both tibial and dorsalis pedis arteries by the highest systolic blood pressure of both brachial arteries using Dopplex® DFK Diabetic Foot Assessment Kit. ABI-APM was obtained in the similar way using Nonin Avant 2120 blood pressure monitor.
Results: The mean ± SD of ABI-APM was 1.12±0.07 in normal, 1.04±0.09 in Risk factor patients and 0.84±0.10 in PAD patients, whereas the mean ± SD of ABI-HHD was 1.08±0.06 in normal, 1.0±0.12 in Risk factor patients and 0.80±0.08 in PAD patients. The mean difference between the two ABI measurements was 0.04±0.12 with ABI-APM providing slightly higher values (P<0.001). The overall correlation of ABI-APM with ABI-HHD was R=0.64, P<0.0001. The sensitivity of ABI-APM to detect ABI-HHD of less than 0.9 was 84% and the specificity was 92%. ABI-APM was found to be less sensitive at detecting low values in patients with nonpalpable pulses on physical examination.
Conclusion(s): Though ABI-APM is feasible, widely available and easy to measure we found that it is not efficient in detecting the low ABI. We found that if the ABI-APM is abnormal especially in patients whose peripheral pulses are not felt. So, we recommend them to have ABI-HHD measurement by the trained professionals to confirm PAD.
Implications: The evaluated ABI-APM can be used as a screening tool for patients in general practice especially in primary health care to detect PAD and may help the family physicians to follow the current clinical screening guidelines for identification of PAD.
Funding, acknowledgements: There is no funding agency for this research project.
Keywords: Ankle Brachial Index, Peripheral Arterial Disease, Vascular screening
Topic: Primary health care
Did this work require ethics approval? Yes
Institution: University of Hail
Committee: Department of Physical Therapy, College of Applied Medical Sciences
Ethics number: IRB-BSPT-201316244
All authors, affiliations and abstracts have been published as submitted.
