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Clinical Characteristics and Angioplasty Outcomes in Lower Extremity Artery Disease Patients with Normal

Yi-Jia Su1,2, Szu-Han Wang3, Po-Wei Chen2,3

  • 1Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liu Branch, College of Medicine, National Cheng Kung University, Yun-Lin.

Acta Cardiologica Sinica
|September 29, 2025
PubMed

Insights

Lower extremity artery disease (LEAD) patients with normal ankle-brachial index (ABI) readings may still experience poor outcomes. This suggests a need for further assessment beyond ABI for these patients.

Area of Science:

  • Vascular Medicine
  • Cardiovascular Research
  • Medical Diagnostics

Background:

  • The resting ankle-brachial index (ABI) is a standard diagnostic tool for lower extremity artery disease (LEAD).
  • Some patients diagnosed with LEAD and undergoing percutaneous transluminal angioplasty (PTA) present with normal ABI values.
  • This observation raises questions about the sufficiency of ABI alone in assessing disease severity and predicting outcomes in certain LEAD patients.

Purpose of the Study:

  • To investigate the clinical characteristics and outcomes of LEAD patients who underwent PTA, stratified by their pre-procedural ABI.
  • To compare the incidence of major adverse cardiovascular and cerebral events (MACCEs) and major adverse limb events (MALEs) between patients with normal ABI and abnormal ABI.
  • To identify potential factors contributing to outcomes in LEAD patients with normal ABI.

Main Methods:

  • A retrospective analysis of consecutive LEAD patients undergoing PTA was conducted.
  • Patients were categorized into two groups: ABI-normal (ABI 0.91-1.40) and ABI-abnormal (ABI ≤ 0.90 or > 1.40).
  • Primary endpoints included MACCEs and MALEs, with a median follow-up of 1.5 years.

Main Results:

  • Of 334 patients, 21% had a normal ABI. The ABI-normal group exhibited higher rates of male gender and chronic kidney disease.
  • Angiography showed less severe femoropopliteal lesions and lower stent deployment rates in the ABI-normal group.
  • Despite differences in lesion severity, MACCEs and MALEs occurred with comparable incidence rates between the ABI-normal and ABI-abnormal groups.

Conclusions:

  • LEAD patients with a normal ABI often have less severe above-the-knee arterial lesions.
  • These patients, however, face similar risks of adverse cardiovascular and limb events as those with abnormal ABI.
  • The findings underscore the necessity for advanced hemodynamic assessments and heightened clinical vigilance in LEAD patients with normal ABI readings.
Abstract

Keywords:
Ankle-brachial indexLower extremity artery diseaseMajor adverse cardiovascular and cerebral eventsMajor adverse limb eventsPercutaneous transluminal angioplasty

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