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A.ÊMeasure highest systolic reading in both arms

1.ÊRecord first doppler sound as cuff is
deflated
2.ÊRecord at the radial pulse
3.ÊUse highest of the two arm pressures
B.ÊMeasure systolic readings in both legs
1.ÊCuff applied to calf
2.ÊRecord first doppler sound as cuff is
deflated
3.ÊUse doppler ultrasound device
a.Ê Record dorsalispedis pressure
b.ÊRecord posterior tibial pressure
Ê Use highest ankle pressure (DP or PT) for each leg
C.ÊCalculate ratio of each ankle to brachial
pressure
Ê Divide each ankle by highest brachial pressure
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Ô.ÊAnkle-Brachial Ratio >1.3: Non-compressable
vessels (see false negatives below)
1.ÊAnkle-Brachial Ratio >Ô.95: Normal
2.ÊAnkle-Brachial Ratio <Ô.95: Peripheral Vascular
Disease
3.ÊAnkle-Brachial Ratio <Ô.6:
Intermittent Claudication
4.ÊAnkle-Brachial Ratio <Ô.5: Multi-level disease
5.ÊAnkle-Brachial Ratio <Ô.26: Resting ischemic
pain
6.ÊAnkle-Brachial Ratio <Ô.2: Gangrenous
extremity
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Ô.ÊResults in falsely elevated ankle pressure
1.ÊConditions where vessels are non-compressable
Ê Diabetes Mellitus
Ê End-stage renal disease (ESRD)
Ê Diffuse arterial calcifications (as in severe or diffuse
PAD)
2.ÊAlternative studies
Ê Toe-brachial ratio (typically Ô.7 to Ô.8)
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A.ÊSegmental Arterial Pressure
B.Ê Other options
Ê Standard angiography
Ê CT angiography
Ê Magnetic resonance angiography
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