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Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication
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Lower extremity amputation risk factors associated with elevated ankle brachial indices and radiographic arterial

Eric Lew1, Nicole Nicolosi1, Georgeanne Botek2

  • 1Resident, Department of Podiatric Medicine and Surgery, Kaiser Permanente Medical Center-Cleveland Clinic, Cleveland, OH.

The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons
|February 10, 2015
PubMed

Insights

An elevated ankle-brachial index (ABI) is as prognostic for lower extremity amputation as a low ABI. This finding highlights the importance of assessing high ABIs in patients with diabetes or kidney disease.

Area of Science:

  • Vascular Medicine
  • Podiatric Medicine
  • Cardiovascular Research

Background:

  • Elevated ankle-brachial index (ABI), often due to Mönckeberg's arteriosclerosis, is common in patients with diabetes mellitus or end-stage renal disease.
  • Recent studies link elevated ABIs to increased cardiovascular morbidity and mortality.
  • The prognostic value of high ABIs compared to low ABIs in predicting lower extremity outcomes requires further evaluation.

Purpose of the Study:

  • To assess the prognostic significance of high ABIs, poorly compressible arteries, and radiographic artery calcification versus low ABIs in predicting lower extremity amputation and morbidity.

Main Methods:

  • Retrospective review of 129 patients who underwent lower extremity amputation between July 1, 2011, and August 31, 2012.
  • Patients were categorized into three groups: low ABI (<0.9), normal ABI (0.9-1.3), and high ABI (>1.3) or poorly compressible arteries.
  • Analysis of comorbidities including diabetes, peripheral arterial disease, chronic kidney disease, coronary artery disease, and tobacco use.

Main Results:

  • A U-shaped relationship was observed between ABI and comorbidity, indicating high ABIs are as prognostic as low ABIs for amputation risk.
  • Prevalence of diabetes was highest in the normal ABI group (p = .016).
  • Significant differences in peripheral arterial disease, chronic kidney disease, coronary artery disease, revascularization history, and tobacco use were found between groups (p < .001 to p = .012).

Conclusions:

  • Elevated ABI, similar to low ABI, is a significant predictor of lower extremity amputation.
  • The study underscores the prognostic importance of high ABI in vascular risk assessment.
  • Further research into the mechanisms and management of high ABI in at-risk populations is warranted.

Keywords:
amputationankle brachial indexartery calcificationdiabetesperipheral arterial disease

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