What is the recommended approach for regular Ankle-Brachial Index (ABI) testing and management of Peripheral Artery Disease (PAD)?

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From the Guidelines

The recommended approach for regular Ankle-Brachial Index (ABI) testing is to screen high-risk individuals, including those over 65, smokers, diabetics, and patients with cardiovascular risk factors, as stated in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1.

Key Points for ABI Testing and PAD Management

  • ABI testing should be performed by measuring systolic blood pressure in both arms and ankles, with a normal ABI range between 0.9-1.4, as recommended by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1.
  • Values below 0.9 indicate PAD, with lower values suggesting more severe disease, and values above 1.4 may indicate noncompressible arteries, often seen in patients with diabetes or chronic kidney disease 1.
  • For PAD management, a comprehensive approach includes:
    • Lifestyle modifications: smoking cessation, regular exercise for 30-45 minutes daily 1.
    • Antiplatelet therapy: aspirin 75-325mg daily or clopidogrel 75mg daily, to reduce cardiovascular risk 1.
    • Statin therapy: atorvastatin 40-80mg or rosuvastatin 20-40mg daily, to reduce cardiovascular risk 1.
    • Blood pressure control: below 140/90 mmHg (or 130/80 mmHg for diabetics) using appropriate antihypertensives 1.
    • Supervised exercise therapy programs: 30-45 minute sessions, 3 times weekly, for at least 12 weeks, are highly effective for symptom management 1.
    • For patients with claudication, cilostazol 100mg twice daily can improve walking distance 1.

Follow-Up and Monitoring

  • Regular follow-up ABI testing should occur annually for stable PAD and more frequently for symptomatic progression, as recommended by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1.
  • This comprehensive approach addresses both symptom management and the underlying atherosclerotic disease process, reducing overall cardiovascular morbidity and mortality, as stated in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1.

From the Research

Recommended Approach for Regular Ankle-Brachial Index (ABI) Testing

  • The ankle-brachial index (ABI) is a highly sensitive and specific test for diagnosing Peripheral Artery Disease (PAD) in patients with significant stenosis 2.
  • However, the utility of ABI in patients with less severe stenosis and calcified vessels is limited 2.
  • It is recommended to measure ABI at rest in patients at risk of PAD in primary care practice 2, 3.
  • If ABI is normal at rest in patients with symptoms of intermittent claudication, exercise testing is recommended to enhance the sensitivity for detection of PAD 2.

Management of Peripheral Artery Disease (PAD)

  • Lifestyle modifications, including diet modification, exercise programs, and smoking cessation, are essential for managing PAD 3, 4.
  • Medical therapy consists of antiplatelet and statin therapies for secondary prevention of vascular complications, and consideration of drugs such as cilostazol for symptom control 3, 4.
  • Patients with acute limb ischemia should be referred emergently for evaluation and possible revascularization 3.
  • Patients with lifestyle-limiting claudication despite lifestyle modification and medical therapy and patients with chronic limb ischemia should be considered for revascularization 3.

Screening for PAD

  • The Edinburgh Claudication Questionnaire (ECQ) and ABI are screening methods to identify the presence of PAD 5.
  • Undiagnosed PAD is common in stable outpatients with a prior history of manifest cardiovascular disease, particularly in those with diabetes 5.
  • The ECQ does not possess the diagnostic value of ABI in detecting PAD, but may be useful to raise suspicion of PAD to be confirmed by ABI assessment 5.

ABI Acquisition Methods

  • Different methods of ABI acquisition, including Doppler-derived and oscillometric ABIs, have been compared for detection of PAD in diabetic patients 6.
  • The lower arterial blood pressure (LABP) calculation provided results superior to the guideline-recommended higher arterial blood pressure (HABP) 6.
  • Patients with high ABI should be automatically considered PAD-positive and referred for further investigation using imaging techniques 6.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

Management of peripheral arterial disease.

American family physician, 2004

6
Research

Comparison of different methods of ABI acquisition for detection of peripheral artery disease in diabetic patients.

Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, 2019

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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