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The ankle-brachial pressure index (ABPI) or ankle-brachial index (ABI) is the ratio of the blood pressure at the ankle to the blood pressure in the upper arm (brachium). Compared to the arm, lower blood pressure in the leg suggests blocked arteries due to peripheral artery disease (PAD).
Measurement is done with the patient lying flat, with feet at heart level, using sphygmomanometry: the big toe is slightly emptied of blood by squeezing, and a small cuff is inflated around the base of the toe. Cuff pressure is then slowly lowered until flow can be detected in the distal part of the toe, e.g. by optical means (photocell), by ...
Ankle-brachial pressure index (ABPI) assesses peripheral vascular disease. It may however be unreliable in patients with calcified arteries in the calf (often diabetic patients) or those with extensive oedema, in which case toe pressure or Toe-brachial pressure index (TBPI) should be measured to aid in the diagnosis.
The ABI is a simple, non-invasive test that measures the ratio of systolic blood pressure in the ankle to the systolic blood pressure in the upper arm. This is based on the idea that if blood pressure readings in the ankle are lower than those in the arm, a blockage in the arteries that provide blood from the heart to the ankle is suspected. [ 55 ]
Vascular doctors and nurses may use special pads to ensure uniform higher pressure around the circumference of the ankle (to smooth out the irregular cross-sectional profile.) Self-prescription is reasonably safe assuming that the compression gradient is 15–20 mmHg, the ABPI (for both legs) is >1.0 and that the stockings fit correctly.
The thick outsoles 'minimize stress on the Achilles tendon,' says Dr. Nelya Lobkova, DPM at Step Up Surgical Podiatry in New York City.
These procedures provide reasonable outcomes that are comparable to surgery with the advantage of short hospital stay (day or overnight for most cases) with lower morbidity and mortality rates. Historically performed by interventional radiologists, vascular surgeons have become increasingly proficient with endovascular methods. [ 5 ]
In a limb with a normal circulation the toes and sole of the foot, stay pink, even when the limb is raised by 90 degrees. In an ischaemic leg, elevation to 15 degrees or 30 degrees for 30 to 60 seconds may cause pallor. (This part of the test checks for elevation pallor.) A vascular angle of less than 20 degrees indicates severe ischaemia. [1] [2]