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CC BY 4.0 · Surg J (N Y) 2021; 07(03): e132-e137
DOI: 10.1055/s-0041-1731444
Original Article

Diagnostic Performance of Ankle-Brachial Pressure Index in Lower Extremity Arterial Disease

Mohammed Alagha
1   Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
,
Thomas M. Aherne 
1   Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
,
Ahmed Hassanin 
1   Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
,
Adeel S. Zafar
1   Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
,
Doireann P. Joyce
1   Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
,
Waqas Mahmood
1   Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
,
Muhammad Tubassam
1   Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
,
Stewart R. Walsh 
1   Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
› Author Affiliations Funding No funding was provided for the conduct of this research.
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Abstract

Introduction Ankle-brachial pressure indices (ABIs) continue to form the basis of diagnostics for lower extremity arterial disease (LEAD). However, there remains a paucity of data to support its accuracy. This study aims to evaluate its diagnostic sensitivity and specificity using established arterial-imaging modalities as a benchmark.

Methods In this retrospective study, a regional, prospectively maintained, vascular laboratory database was interrogated to identify referred patients with arterial disease who underwent concomitant assessment with ABI and lower limb arterial duplex ultrasound (DUS). Duplex acted as the reference standard. Those who had peripheral computed tomography angiogram (CTA) within 3 months of initial assessment were included in a subgroup analysis to correlate ABI with CTA. The primary end point was the sensitivity and specificity of ABI compared with DUS as the reference standard.

Results Concomitant assessment was performed in 438 limbs (250 patients) over a 27-month period. The ABI was normal (0.9 to 1.4) in 196 limbs (44.9%) and abnormal in the remaining 241 limbs (55.1%). False-positive results occurred in 83 out of 241 limbs (34.4%), and false-negative results occurred in 54 limbs out of 196 (27.5%). True-positive results were 158 out of 241 limbs (65.6%), whereas true-negative results were 142 out of 196 limbs (72.4%). ABI using DUS as a benchmark identified a sensitivity for peripheral artery disease of 72.3% and a specificity of 69.3%. Concomitant CTA imaging was available in 200 limbs. The sensitivity and specificity of ABI correlated with CTA were 65.5 and 68.8%, respectively.

Conclusion ABIs have a moderate predictive value in the diagnosis of LEAD. Normal range outcomes cannot be taken to infer the absence of LEAD and, as such, further arterial imaging in the form of DUS or angiography should be strongly considered in those with suspected underlying disease requiring intervention. Further noninvasive tests such as exercise studies or pulse volume waveforms should be considered, if diagnostic uncertainty exists, in those requiring nonoperative intervention and risk factor control.

Keywords

ankle-brachial pressure index - peripheral arterial disease - duplex Doppler ultrasonography - CT angiography

Author Contributions

MA conceptualized, designed, wrote, and reviewed the manuscript.


TA wrote and reviewed the manuscript.


AH analyzed the manuscript.


AZ conceptualized and reviewed the manuscript.


DJ designed and reviewed the manuscript.


WM conceptualized and reviewed the manuscript.


MT reviewed the manuscript.


SRW designed, analyzed, and reviewed the manuscript.




Publication History

Received: 09 October 2020

Accepted: 17 May 2021

Article published online:
19 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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