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Heterogeneity of Ankle-Brachial Indices in Patients Undergoing Revascularization for Critical Limb Ischemia

Devraj Sukul1, Scott F Grey1, Peter K Henke2

  • 1Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.

JACC. Cardiovascular Interventions
|November 25, 2017
PubMed

Insights

Ankle-brachial index (ABI) measurements in critical limb ischemia (CLI) patients show significant variation before revascularization, questioning the test's utility and suggesting a need for standardized peripheral artery disease (PAD) testing.

Area of Science:

  • Vascular Medicine
  • Noninvasive Diagnostic Testing
  • Peripheral Artery Disease

Background:

  • Critical limb ischemia (CLI) is characterized by rest pain, ulceration, or gangrene due to chronic arterial insufficiency.
  • The proportion of CLI patients with severe peripheral artery disease (PAD) on noninvasive testing is not well-defined.
  • Ankle-brachial index (ABI) is a key noninvasive test for PAD.

Purpose of the Study:

  • To describe the distribution of pre-intervention ankle-brachial indices (ABIs) in patients with critical limb ischemia (CLI).
  • To analyze ABI variations in patients undergoing percutaneous vascular intervention (PVI) or surgical revascularization (SR).
  • To evaluate the utility of ABIs in diagnosing PAD in the context of CLI.

Main Methods:

  • A multicenter registry of patients with CLI undergoing lower extremity revascularization (January 2012-June 2015) was analyzed.
  • Pre-intervention ABIs were classified as normal (0.91-1.40), mild-moderate (0.41-0.90), or severe (≤0.40).
  • Peripheral Artery Questionnaire (PAQ) scores were assessed pre- and post-intervention in a subset of patients.

Main Results:

  • Of 10,756 CLI patients, 9,113 (84.7%) had PVI and 1,643 (15.3%) had SR.
  • ABIs were available for 54.6% of PVI and 61.6% of SR patients.
  • PVI patients had higher mean ABIs (0.72 ± 0.29) than SR patients (0.61 ± 0.29; p < 0.001).
  • 24.0% of patients with compressible arteries had normal ABIs; severe PAD was found in 16.5%.
  • Significant PAQ score improvement occurred post-intervention across all ABI categories.

Conclusions:

  • Substantial heterogeneity exists in pre-intervention ABIs among CLI patients undergoing revascularization.
  • The discrepancy between ABI results and clinical diagnosis challenges the current utility of ABIs in this population.
  • Standardization of functional PAD testing is recommended for improved diagnostic accuracy in CLI patients.
Abstract

Keywords:
ankle-brachial indexcritical limb ischemiapercutaneous vascular interventionperipheral artery diseasesurgical bypass graft

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