INFORMATION FOR THE CANDIDATE: You are

the resident in the vascular unit and your registrar asks

you to explain how to measure the ankle brachial index
and what importance it has for the evaluation of a
patient.
Your tasks are to:
1. Explain the meaning of the ankle brachial index
(ABI) to the medical student
2. Outline the procedure

The Ankle Brachial Index (ABI) test is a popular tool

for the non-invasive assessment of peripheral vascular
disease (PVD). This test is done by measuring blood
pressure at the ankle and in the arm while a person is
at rest.
It is very important in patients with risk factors for PVD like smoking, diabetes, overweight
(BMI >25), high blood pressure or high cholesterol!
Measurements are usually repeated at both sites after 5 minutes of walking on a treadmill.
The ABI can be derived by dividing the highest ankle systolic pressure by the arm systolic
blood pressure. This measurement adds a degree of objectivity to the detection and grading of
any arterial occlusive disease present.
As shown in the below diagram the interpretation is outlined and on can relate the values to
clinical presentations:
Normal range
>0.95
Intermittent claudication
0.9 0.4
Rest pain
0.4 0.15
Gangrene
< 0.15
In patients with diabetes, heavy smoking or chronic renal failure their arterial walls may be
calcified and not compressible by a blood pressure cuff, resulting in falsely elevated ABI
determination!

Measurement of the ankle-brachial index

In order to calculate the ankle-brachial index (ABI), systolic blood pressure is measured by
Doppler ultrasonography in each arm and in the dorsalis pedis (DP) and posterior tibial (PT)
arteries in each ankle. The higher of the two arm and ankle pressures is selected. The right and
left ABI values are determined by dividing the higher ankle pressure in each leg by the higher arm
pressure. A ratio greater than 1.30 suggests a noncompressible, calicified vessel; in this situation,
the true pressure at that location cannot be obtained, and additional tests are required to diagnose
peripheral arterial disease. Patients with claudication typically have ankle-brachial index values
ranging from 0.41 to 0.90, and those with critical leg ischemia have values of 0.40 or less.