From the Guidelines
Ankle-brachial index (ABI) and segmental pressure and pulse volume recordings are necessary to correlate with arterial duplex scan because they provide a comprehensive assessment of peripheral artery disease (PAD).
Key Components of Noninvasive Hemodynamic Testing
- ABI: measures the ratio of ankle to brachial systolic blood pressure, with values <0.9 indicating PAD and values >1.3 indicating noncompressible vessels 1
- Segmental pressure measurements: compare systolic pressures at sequential levels in the extremities to evaluate for significant drops between one level and the next, allowing for the localization of disease 1
- Pulse volume recordings: provide a qualitative measurement of limb perfusion, allowing for the assessment of arterial blood flow at each station simultaneously 1
Importance of Correlating with Arterial Duplex Scan
- Arterial duplex scan: provides a detailed assessment of arterial anatomy and blood flow, but has limitations in detecting complete occlusions and characterizing arterial occlusive lesions 1
- Correlation with noninvasive hemodynamic testing: allows for a more accurate diagnosis and assessment of PAD, as well as the planning of interventions 1
- Clinical guidelines: recommend the use of ABI and segmental pressure and pulse volume recordings in conjunction with arterial duplex scan for the diagnosis and management of PAD 1
From the Research
Importance of Ankle-Brachial Index (ABI) and Segmental Pressure and Pulse Volume Recordings
The ankle-brachial index (ABI) and segmental pressure and pulse volume recordings are necessary to correlate with arterial duplex scan for the following reasons:
- They provide a comprehensive assessment of peripheral arterial disease (PAD) by evaluating the severity and extent of the disease 2
- The combination of ABI, segmental limb pressures, and pulse volume recordings improves diagnostic accuracy for PAD compared to using ABI alone 3, 4, 5
- These tests can detect early PAD lesions and improve diagnostic sensitivity, particularly in asymptomatic cases or those with high atherosclerotic cardiovascular risks 3, 4, 6
Diagnostic Accuracy of Combined Tests
The diagnostic accuracy of combined tests, such as ABI and pulse volume recording (PVR) parameters, is higher than using ABI alone:
- The combination of ABI, percentage of mean arterial pressure (%MAP), and upstroke time (UT) achieved higher sensitivity, negative predictive value, and accuracy than ABI alone 3
- The combination of ABI and %MAP improved diagnostic sensitivity for PAD, particularly in subjects with a normal ABI 4
- The combination of ABI and PPG parameters, such as PPGratio and PPGamp, exhibited improved performance in diagnosing PAD compared to ABI alone 6
Clinical Implications
The use of combined tests, such as ABI and segmental pressure and pulse volume recordings, has significant clinical implications:
- They can improve diagnostic accuracy and sensitivity for PAD, leading to early detection and treatment 3, 4, 6, 5
- They can provide crucial insights into major adverse cardiac events and all-cause mortality risks 6
- They can help identify patients with high atherosclerotic cardiovascular risks, allowing for targeted interventions and management 6