Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery

Ankle-brachial index – the primary non-invasive screening test for the diagnosis of diseases of the lower limb arteries: the possibilities and limitations of the method

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Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation

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DOI: https://doi.org/10.24022/1814-6910-2020-17-3-183-188

UDC: 616.13/.14

Link: Clinical Physiology of Blood Circulaiton. 2020; 17 (3): 183-188

Quote as: Shumilina M.V., Keren M.A., Khadzegova O.A. Ankle-brachial index – the primary non-invasive screening test for the diagnosis of diseases of the lower limb arteries: the possibilities and limitations of the method. Clinical Physiology of Circulation. 2020; 17 (3): 183–8 (in Russ.). DOI: 10.24022/1814-6910-2020-17-3-183-188

Received / Accepted:  12.05.2020/18.05.2020

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Abstract

Patients with atherosclerosis of the arteries of the lower extremities have a significantly increased risk from cardiovascular diseases. Moreover, these patients often have an asymptomatic course of the disease, which is usually associated with the presence of concomitant pathology. Because of this, special attention take note to issues of timely detection of the disease, especially among patients with presumed risk factors (such as coronary heart disease, diabetes mellitus, smokers, etc.). According to current recommendations for the diagnosis and treatment of diseases of peripheral arteries, it has indicated that the ankle-brachial index (ABI) is the main screening test that allows you to recognize significant atherosclerosis of lower limb arteries in time. In the case of a false positive systolic ABI due to poor compressibility of the arteries, measuring the diastolic ankle-brachial index can give an objective idea of arterial blood flow in the lower extremities. ABI can also be used to screen for other diseases. To improve the quality of assessing lesions of the arteries of the lower extremities by the screening method, a comprehensive analysis of factors is performed: the morphology of the dopplerogram is evaluated; the indices of regional systolic pressure, linear blood flow velocities, and indices of peripheral resistance are calculated.

References

  1. AboyansV., Jean-Baptiste R., Bartelink M.E.L., Björck M., Brodmann M., Cohnert T. et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur. Heart J. 2018; 39: 763–821. 
  2. Рекомендации ЕОК/ЕОСХ по диагностике и лечению заболеваний периферических артерий 2017. Российский кардиологический журнал. 2018; 23 (8): 197. DOI: 10.15829/1560-4071-2018-8-164-221 [2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Russian Journal of Cardiology. 2018; 23 (8): 197 (in Russ.). DOI: 10.15829/1560-4071-2018-8-164-221] 
  3. Fowkes F.G., Murray G.D., Butcher I., Heald C.L., Lee R.J., Chambless L.E. et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008; 300 (2): 197–208. DOI: 10.1001/jama. 300.2.197 
  4. Criqui M.H., McClelland R.L., McDermott M.M., Allison M.A., Blumenthal R.S., Aboyans V. et al. The ankle-brachial index and incident cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis). J. Am. Coll. Cardiol. 2010; 56: 1506–12. DOI: 10.1016/ j.jacc.2010.04.060 
  5. Fowkes F.G.R., Rudan D., Rudan I., Aboyan S.V., Denenberg J.O., McDermott M.M. et al. 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. DOI: 10.1016/S0140-6736(13)61249-0 
  6. Шумилина М.В. Комплексная ультразвуковая диагностика патологии периферических сосудов: Учебно-методическое руководство. 2-е изд. М.: НЦССХ им. А.Н. Бакулева РАМН; 2012: 17–20. [Shumilina M.V. Integrated ultrasound diagnosis of peripheral vascular pathology: A training manual. 2nd ed. Moscow; 2012: 17–20 (in Russ.).] 
  7. Шумилина М.В., Аракелян В.С. Алгоритм неинвазивной диагностики при ишемии нижних конечностей. Методические рекомендации. М.: НМИЦССХ им. А.Н. Бакулева; 2019: 21–3. [Shumilina M.V., Arakelyan V.S. Non-invasive diagnostic algorithm for lower limb ischemia. Guidelines. Moscow; 2019: 21–3 (in Russ.).] 
  8. Xu D., Zou L., Xing Y., Hou L., Wei Y., Zhang J. et al. Diagnostic value of ankle-brachial index in peripheral arterial disease: a metaanalysis. Can. J. Cardiol. 2013; 29: 492–8. DOI: 10.1016/j.cjca.2012.06.014 
  9. Aboyans V., Criqui M.H., Abraham P., Allison M.A., Creager M.A., Diehm C. et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012; 126: 2890–909. DOI: 10.1161/cir. 0b013e318276fbcb 
  10. Menke A., Muntner P., Wildman R.P., Dreisbach A.W., Raggi P. Relation of borderline peripheral arterial disease to cardiovascular disease risk. Am. J. Cardiol. 2006; 98: 1226–30. DOI: 10.1016/j.amjcard.2006. 05.056 
  11. Ahn S., Park Y.J., Min S.I., Kim S.Y., Ha J., Kim S.J. et al. High prevalence of peripheral arterial disease in Korean patients with coronary or cerebrovascular disease. J. Korean Med. Sci. 2012; 27: 625–9. DOI: 10.3346/jkms.2012.27.6.625 
  12. Fowkes F.G., Housley E., Cawood E.H., Macintyre C.C., Ruckley C.V., Prescott R.J. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int. J. Epidemiol. 1991; 20: 384–92. DOI: 10.1093/ije/20.2.384 
  13. Lamina C., Meisinger C., Heid I.M., Löwel H., Rantner B., Koenig W. et al. for the KORA Study Group. 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: 2580–7. DOI: 10.1093/eurheartj/ehl228 
  14. Diehm N., Diehm C. Subclinical atherosclerosis of lower limb arteries: a strong predictor for cardiovascular mortality. Eur. Heart J. 2006; 27: 2495–6. DOI: 10.1093/ eurheartj/ehl283 
  15. Agnelli G., Cimminiello C., Meneghetti G., Urbinati S.; Polyvascular Atherothrombosis Observational Survey (PATHOS) Investigators. Low ankle-brachial index predicts an adverse 1-year outcome after acute coronary and cerebrovascular events. J. Thromb. Haemost. 2006; 4 (12): 2599–606. DOI: 10.1111/j.1538-7836.2006. 02225.x 
  16. Visonà A., De Paoli A., Fedeli U., Tonello D., Zalunardo B., Zanatta N. et al. Abnormal Ankle-Brachial Index (ABI) predicts primary and secondary cardiovascular risk and cancer mortality. Eur. J. Intern. Med. 2020. DOI: 10.1016/j.ejim.2020.02.033 
  17. Chen H.Y., Wei F., Wang L.H., Wang Z., Meng J., Yu H.B. et al. Abnormal ankle-brachial index and risk of cardiovascular or all-cause mortality in patients with chronic kidney disease: a meta-analysis. J.Nephrol. 2017; 30 (4): 493–501. DOI: 10.1007/s40620-017-0376-z 
  18. Спиридонов А.А., Бузиашвили Ю.И., Шумилина М.В. Ультразвуковая диагностика патологии артерий нижних конечностей: Учебно-методическое руководство. М.: Спектромед; 1996. [Spiridonov A.A., Buziashvili Yu.I., Shumilina M.V. Ultrasound diagnosis of pathology of lower limb arteries: Training methodical leadership. Moscow: Spektromed; 1996 (in Russ.).] 
  19. Шумилина М.В. Комплексная ультразвуковая диагностика патологии периферических сосудов. М.: Издательство НЦССХ им. А.Н. Бакулева РАМН; 2007: 20. [Shumilina M.V. Complex ultrasound diagnosis of peripheral vascular pathology. Moscow; 2007: 20 (in Russ.).] 
  20. Asbeutah A.M., Al Majran A.A., Asfar S.K. Diastolic versus systolic ankle-brachial pressure index using ultrasound imaging & automated oscillometric measurement in diabetic patients with calcified and noncalcified lower limb arteries. BMC Cardiovascular Disorders. 2016; 16: 202. DOI: 10.1186/s12872-016-0377-1 
  21. Salles-Cunha S.X., Braga F.A., Caiafa J.S., Melo H.A. Diastolic ankle-brachial indices as a complementary measure to screen for peripheral arterial disease in diabetic patients. J. Vasc. Ultrasound. 2012; 36 (3): 205–9. DOI: 10.1177/154431671203600303

About Authors

  • Margarita V. Shumilina, Dr. Med. Sc., Head of Group of Ultrasound Studies of Cardiovascular and Organ Pathology, Professor of Chair of Cardiology and Functional Diagnostics, Institute of Training of Highly Gualified Personnel and Professional Education (ITHGP and PE); orcid.org/0000-0001-9871-8173 
  • Milena A. Keren, Dr. Med. Sc., Professor of Chair of Cardiology and Functional Diagnostics, ITHGP and PE; orcid.org/0000-0003-2428-1559 
  • Olesya A. Khadzegova, Resident Physician of Chair of Cardiology and Functional Diagnostics, ITHGP and PE

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