Ankle-arm index

The ankle-arm index , (English scientific term: ankle-brachial-index (ABI)), Doppler index , also tibio-brachial quotient (TBQ), cruro-brachial quotient (CBQ), or occlusion pressure measurement , is called by measuring blood pressure and Doppler sonography . The ankle-arm index is determined to estimate the overall cardiovascular risk and, in patients with peripheral arterial occlusive disease, to diagnose and assess hemodynamic compensation and to assess the course.

execution

The patient must be in a lying position (head can be supported with a pillow). Lying time before the measurement 10 min. Then, one after the other, a blood pressure cuff is placed far down on both lower legs and on both upper arms and pressure is built up until it exceeds the systolic pressure of the vessels. The Doppler probe is placed over a vessel distal to the blood pressure cuff and when the pressure is reduced it determines when blood starts to flow again. The re-entry of the pulse noise audible via the Doppler corresponds to the systolic vascular pressure of the examined vessel at the level of the cuff. Blood pressure fluctuations that occur during the measurement can influence the results. Specialized devices can measure blood pressure on all four extremities at the same time, which means that blood pressure fluctuations do not affect the measurement result.

The arteriae radialis , dorsalis pedis and tibialis posterior are usually used for the examination with the Doppler .

evaluation

The ankle-arm index is the quotient of the systolic blood pressures measured on the lower leg and upper arm (RR systolic ankle / RR systolic arm). A quotient of 0.9 to 1.3 is considered normal. The smaller the quotient, the greater the extent of the circulatory disorder. Values below 0.9 define the PAD . Values below 0.5 usually already imply clinical ischemia with a very high risk of necrosis and ulcers . Values above 1.3 indicate a special type of vascular calcification ( medial sclerosis ).

ABI value	Severity of PAOD
> 1.3	wrongly high values (suspected media sclerosis)
> 0.9	Normal findings
0.75-0.9	slight PAOD
0.5-0.75	moderate PAOD
<0.5	severe PAOD (critical ischemia)

Since one value is measured for each leg across two different vessels, it is currently in line with guidelines to use the higher of the two ankle pressures when forming the quotient (ABI value) to make a diagnosis. For the arms, the mean value of the pressures measured on both arms is used if the difference between the two measurements is less than 10 mmHg. If the difference is greater, the higher value of both arms is used. With systolic blood pressures above 200 mmHg this test is contraindicated and gives incorrect values.

Measurement example

Measurement on the upper arm 100 mmHg, measurement on the lower leg 50 or 60 mmHg. The ankle-arm index is then 0.6.

Individual evidence

↑ Curt Diehm, Harald Darius, David Pittrow, Jens R. Allenberg: Knöchel-Arm-Index. A groundbreaking risk marker for general practitioners. In: Deutsches Ärzteblatt. Vol. 102, Issue 34-35, August 29, 2005, pp. A-2310-A-2313. (PDF; 110 kB)
↑ ^a ^b Guideline on peripheral arterial occlusive disease (PAD). Diagnostics and therapy of the working group of scientific medical societies
↑ ^a ^b Holger Lawall, Curt Diehm: Guidelines for the diagnosis and therapy of peripheral arterial occlusive disease (PAD) . In: Guidelines for the diagnosis and treatment of peripheral arterial occlusive disease (PAD) ( Memento of July 10, 2012 in the Internet Archive ) . April 27, 2009.
↑ ^a ^b laekh.de ( Memento of the original from March 14, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2
↑ F. Schröder, N. Diehm, S. Kareem, M. Ames, A. Pira, U. Zwettler, H. Lawall, C. Diehm: A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease. In: J Vasc Surg . 44 (3), 2006, pp. 531-536.
↑ C. Espinola-Klein, HJ Rupprecht, C. Bickel, K. Lackner, S. Savvidis, CM Messow, T. Munzel, S. Blankenberg: Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction. In: Circulation . 118 (9), 2008, pp. 961-967.

[1] Curt Diehm, Harald Darius, David Pittrow, Jens R. Allenberg: Knöchel-Arm-Index. A groundbreaking risk marker for general practitioners. In: Deutsches Ärzteblatt. Vol. 102, Issue 34-35, August 29, 2005, pp. A-2310-A-2313. (PDF; 110 kB)

[:0-2] Guideline on peripheral arterial occlusive disease (PAD). Diagnostics and therapy of the working group of scientific medical societies

[leitlinie-2009-3] Holger Lawall, Curt Diehm: Guidelines for the diagnosis and therapy of peripheral arterial occlusive disease (PAD) . In: Guidelines for the diagnosis and treatment of peripheral arterial occlusive disease (PAD) ( Memento of July 10, 2012 in the Internet Archive ) . April 27, 2009.

[laekh-4] .de ( Memento of the original from March 14, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2

[5] F. Schröder, N. Diehm, S. Kareem, M. Ames, A. Pira, U. Zwettler, H. Lawall, C. Diehm: A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease. In: J Vasc Surg . 44 (3), 2006, pp. 531-536.

[6] C. Espinola-Klein, HJ Rupprecht, C. Bickel, K. Lackner, S. Savvidis, CM Messow, T. Munzel, S. Blankenberg: Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction. In: Circulation . 118 (9), 2008, pp. 961-967.