Palpating Ankle Pulses is Insufficient in Detecting Arterial Insufficiency in Patients with Leg Ulceration

1994 ◽  
Vol 9 (4) ◽  
pp. 170-172 ◽  
Author(s):  
C. J. Moffatt ◽  
M. I. Oldroyd ◽  
R. M. Greenhalgh ◽  
P. J. Franks
Keyword(s):  
Lower Limb ◽  
Outcome Measure ◽  
Arterial Disease ◽  
Ankle Brachial Pressure Index ◽  
Main Outcome Measure ◽  
Pressure Index ◽  
Poor Predictor ◽  
Pulse Palpation ◽  
District Nurses ◽  
Arterial Insufficiency

Objective: To investigate the ability of district nurses to detect lower limb arterial disease by palpation of ankle pulses. Design: Ankle pulse palpation of patients presenting with ulcerated limbs and comparison with Doppler ankle-brachial pressure index (ABPI). Patients: Sequential patients presenting to community ulcer clinics. Main outcome measure: Sensitivity and specificity of pulse palpation to detect arterial disease compared with ABPI. Results: Of 533 limbs with ulceration in 462 patients (mean age 74 years, 67% female), 167 (31%) had no detectable pulses at the ankle. Of the 93 limbs with ABPI <0.9, 34 (37%) had detectable pulses. Of those limbs with ABPI ≥ 0.9, 108 out of 440 (25%) had no detectable ankle pulses. Sensitivity for lack of pulses as a predictor of arterial disease (ABPI <0.9) was 63% with a specificity of 75% and positive predictive value of only 35%. Using only the absence of palpable pulses would lead to 37% of patients with arterial disease being treated inappropriately. Conclusion: Palpation of pedal pulses by community nurses is a poor predictor of leg arterial disease and must be used in combination with ABPI. Only when significant arterial disease is excluded should compression be applied.

Ankle Brachial Pressure Index and compression application: Review summary

2019 ◽  
Vol 27 (2) ◽  
pp. 74-77
Author(s):  
Victoria Team ◽  
Georgina Gethin ◽  
John D Ivory ◽  
Kimberley Crawford ◽  
Ayoub Bouguettaya ◽  
...  
Keyword(s):  
Content Analysis ◽  
Clinical Practice ◽  
Venous Insufficiency ◽  
Arterial Disease ◽  
Leg Ulcers ◽  
Current Clinical Practice ◽  
Ankle Brachial Pressure Index ◽  
Arterial Circulation ◽  
Pressure Index ◽  
Peripheral Arterial

Venous leg ulcers (VLUs) are a significant complication amongst persons with chronic venous insufficiency (CVI) that frequently follow a cycle of healing and recurrence. Current clinical practice guidelines (CPGs) recommend applying below knee compression to improve VLU healing. Compression could be applied if the Ankle Brachial Pressure Index (ABPI) rules out significant arterial disease, as sufficient peripheral arterial circulation is necessary to ensure safe compression use. We conducted a content analysis of 13 global CPGs on the accuracy of recommendations related to ABPI and compression application. Eight CPGs indicated that compression is recommended when the ABPI is between 0.8 and 1.2 mmHg. However, this review found there is disagreement between 13 global VLU CPGs, with a lack of clarity on whether or not compression is indicated for patients with ABPIs between 0.6 and 0.8 mmHg. Some CPGs recommend reduced compression for treatment of VLUs, while others do not recommend any type of compression at all. This has implications for when it is safe to apply compression, and the inconsistency in evidence indicates that specialist advice may be required at levels beyond the ABPI “safe” range listed above.

Ankle Brachial Pressure Index: An update for the vascular specialist and general practitioner

Vascular ◽  
2019 ◽  
Vol 27 (5) ◽  
pp. 560-570 ◽  
Author(s):  
Benjamin Thurston ◽  
Joseph Dawson
Keyword(s):  
Blood Pressure ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Cardiac Risk Factor ◽  
Diabetic Patients ◽  
Ankle Brachial Pressure Index ◽  
Pressure Index ◽  
Clinical Scenarios ◽  
Invaluable Tool ◽  
Peripheral Arterial

Objectives Ankle brachial pressure index (ABPI) is an invaluable tool for assessing the severity of peripheral arterial disease. In addition, it can be used as an independent marker of cardiovascular risk, with a predictive ability similar to the Framingham criteria. Identification of an abnormal ABPI should therefore trigger aggressive cardiac risk factor modulation for a patient. Unfortunately, the significance of abnormal ABPIs is poorly understood within the general medical community. This is compounded by the influence of various comorbidities on accurate measurement of ABPI, potentially leading to a wide variability in readings that need to be considered before interpretation in these patient populations. We aim to address these issues by revealing several common misunderstandings and pitfalls in ABPI measurement, describing accurate methodology, and highlighting patient cohorts in whom additional or alternative approaches may be required. Methods We present a narrative review of the role of ABPI in both the community and hospital setting. We have performed a literature review, exploring the validity and reproducibility of methodology for obtaining ABPI, alongside the utility of ABPI in different clinical scenarios. Results The measurement of ABPI is often performed incorrectly. Common pitfalls include inadequate patient preparation, failure to obtain the blood pressure from the correct lower limb artery in patients with tibial disease, failure to account for differences in brachial blood pressure between the arms, inappropriately chosen equipment and patient factors such as highly calcified arteries. Standardisation of methodology greatly improves reliability of the test. Exercise ABPI can identify significant peripheral arterial disease in patients with normal resting ABPI. In addition to its role in peripheral arterial disease, ABPI measurement has a role in assessing venous ulcers, entrapment syndromes and injured extremities; conversely, it has a more limited utility in the diabetic population. Conclusions A thorough understanding of the correct technique and associated limitations of ABPI measurement is essential in accurately generating and interpreting the data it provides. With this knowledge, the ABPI is an invaluable tool to help manage patients with peripheral arterial disease. Perhaps more importantly, ABPI can be used to identify and risk stratify patients with asymptomatic peripheral arterial disease, itself a major indicator of significant underlying cardiovascular disease. With the emergence of best medical therapy, targeted pharmacotherapy and lifestyle changes can reduce the risk of major cardiovascular events in high-risk patients by approximately 30%, particularly in diabetic patients. Therefore, the utility of ABPI transgresses vascular surgery, with an essential role in general practice and public health.

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