Efficacy of ankle-brachial index as a preoperative screening in spine surgery

The aims of this study were to investigate the prevalence of peripheral arterial disease (PAD) and specify the patients who are necessary to measure ankle-brachial index (ABI) as a preoperative PAD screening in spine surgery.

A total of 1425 consecutive patients with non-emergency spine surgery underwent a PAD screening using ABI measurement. We reviewed their ABI data, age, smoking status, and co-morbidities including diabetes mellitus (DM), cerebrovascular disease (CVD) and ischemic heart disease (IHD). CT- or MR-angiography was used for a definitive diagnosis of PAD when the ABI was 0.9 or less.

Of 1425 patients, 37 patients (2.5%) showed less than 0.9 in ABI; 24 patients (1.6%) were eventually diagnosed as PAD. Of 24 patients with PAD, 22 patients (91.6%) were over 65 years. The prevalence of DM was 58.3% in the PAD group versus 18.7% in the non-PAD group (P < 0.05). Patients with CVD or IHD were more likely to have PAD, but the differences were not significant. Smoking rate was 62.5% in the PAD group versus 42.4% in the non-PAD group (P < 0.05).

The current preoperative PAD screening data showed that age over 65 years, DM and smoking habit were the risk factors for PAD development. Based on the current results, we advocate preoperative ABI measurement for over 50-year patients who had co-morbidities and/or smoking habit and all the patients aged 65 years or more.