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Incompressible ankle arteries predict increased morbidity and mortality in patients with an elevated ankle brachial

Mirjami Laivuori1, Essi Peltonen2, Maarit Venermo1

  • 1Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Finland.

Vascular
|September 16, 2022
PubMed

Insights

Patients with ankle-brachial index (ABI) over 1.3, especially those with incompressible arteries, face higher cardiovascular mortality. Toe pressure measurement is valuable for assessing risk in these high-risk individuals.

Area of Science:

  • Vascular Medicine
  • Cardiovascular Disease Risk Assessment

Background:

  • An elevated ankle-brachial index (ABI) > 1.3 is associated with increased disease burden and poorer outcomes.
  • Detailed analysis of patient subgroups with ABI > 1.3 is lacking.

Purpose of the Study:

  • To analyze the morbidity and mortality in patients with an ankle-brachial index (ABI) > 1.3.
  • To differentiate outcomes based on the severity of ankle artery calcification indicated by ABI values.

Main Methods:

  • Patients with ABI > 1.3 were recruited from Turku University Hospital (2011-2013).
  • Participants were categorized into three groups based on ABI values: 1.3-2.5 (group 1), one limb ABI ≥ 2.5 (group 2), and both limbs ABI ≥ 2.5 (group 3).

Main Results:

  • Groups 2 and 3 exhibited higher prevalence of female sex, older age, diabetes, coronary artery disease, and chronic heart and kidney failure compared to group 1.
  • Patients in groups 2 and 3 had significantly poorer survival rates (HR 1.6 and 1.7, respectively) and higher overall and cardiovascular mortality.
  • A subset of patients with incompressible arteries (ABI ≥ 2.5) had low toe pressure (<50 mmHg) and worse survival.

Conclusions:

  • Incompressible ankle arteries (ABI ≥ 2.5) are linked to significantly higher mortality and disease burden compared to measurable but high ABI.
  • Toe pressure is a valuable tool for risk assessment when ABI is immeasurably high.
  • All individuals with an ABI > 1.3 should be classified as high cardiovascular risk.
Abstract

Keywords:
Ankle brachial indexarterial stiffeningcardiovascular mortalitylower extremity artery diseasemedial arterial calcificationtoe pressure

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