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Discussion

Polemic about Ankle Brachial Index

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The clinical importance of the early identification of PAD as a manifestation of generalized atherothrombotic disease has been increasingly acknowledged in recent years: the presence of PAD is a powerful predictor of future cardiovascular and cerebrovascular events and of increased mortality.

Ankle brachial index (ABI) offers a simple and effective method of objectively documenting the functional state of the circulation in the lower limb and thus for the diagnosis of lower extremity PAD. However, there is much confusion in the medical sector about the proper procedure for the measurement of ABI (Ankle Brachial Index).

When measuring ABI with a Doppler, does one use the tibial posterior artery or the tibial anterior artery? And what about the Dorsalis Pedis? Vascular specialists seem to use the lowest of the 3 readings in their calculations, cardiologists seem to use the highest and GPs use the most convenient one. So what is the correct procedure? The answer: there is none, it has not yet been really defined. Whilst "better" (better because more PAD are found) results are achieved by using the lowest of the 3 systolics (tibial posterior artery, tibial anterior artery or Dorsalis Pedis), it does not address the main problem, which is that at the moment every GP and cardiologist is doing it differently and that there is thus no parity in the results from one doctor to the next.

Therein lies the interest in the introduction of an oscillometric system to measure ABI, because even if the oscillometric device measures the highest systolic (between the tibial posterior artery, tibial anterior artery and Dorsalis Pedis), it has one undeniable advantage in that it standardizes the method and makes the measurement of ABI accessible to all doctors. And this is where the big advantage is; At the moment GPs simply don't measure ABI because they either don't have the equipment or they don't have the time. An oscillometric device to measure ABI makes the measurement of ABI possible in 3 minutes, with very little margin for handling errors and is easy to perform with minimum training. It should be used as a pre-screening tool for the GP. This would have a huge impact on the vascular health of patients as many cases of PAD could be detected before it is too late and the patient has to see a vascular specialist.