In adult patients after iliac artery stenting, how soon should the ankle‑brachial index be measured?

Timing of ABI Measurement After Iliac Artery Stenting

Check the ankle-brachial index immediately before hospital discharge and again at 1 month post-procedure to establish a new baseline and detect early restenosis or technical complications.

Immediate Post-Procedure Assessment

The available guidelines do not provide specific timing recommendations for ABI measurement after iliac artery stenting. However, the 2024 ESC guidelines emphasize that ABI is a fundamental tool for assessing hemodynamic success of revascularization procedures and should be used for surveillance of PAD interventions 1.

Recommended Timing Protocol

Based on standard vascular practice principles and the role of ABI in post-intervention surveillance:

• Measure ABI before discharge (typically 24-48 hours post-stenting) to:

  • Document technical success and improved perfusion 1
  • Establish a new post-intervention baseline for comparison 1
  • Detect immediate procedural complications or inadequate revascularization 1

• Repeat ABI at 1 month post-procedure to:

  • Confirm sustained hemodynamic improvement 1
  • Identify early restenosis or stent thrombosis 1
  • Guide further management decisions 1

Measurement Technique Post-Stenting

• Perform ABI measurement with the patient supine after 5-10 minutes of rest in a temperature-controlled room 1, 2
• Use standardized Doppler technique measuring bilateral brachial and ankle pressures 1
• Calculate ABI using the higher ankle pressure (posterior tibial or dorsalis pedis) divided by the higher brachial pressure for diagnostic accuracy 2, 3

Interpretation of Post-Intervention ABI

• Successful revascularization typically produces an ABI increase of ≥0.15 from baseline 1
• A normal post-procedure ABI (0.91-1.40) indicates adequate restoration of flow 1, 2
• Failure to improve ABI or a decline from immediate post-procedure values suggests technical failure, restenosis, or distal disease 1

Long-Term Surveillance

• After the 1-month assessment, repeat ABI at 6 months, 12 months, and annually thereafter to monitor for late restenosis 1
• More frequent monitoring may be warranted in patients with diabetes, chronic kidney disease, or multilevel disease 1

Important Caveats

• In patients with diabetes or chronic kidney disease, ABI >1.40 due to arterial calcification may mask residual disease; consider toe-brachial index (TBI >0.70 is normal) as an alternative 1, 2
• If post-procedure ABI remains <0.90 despite technically successful stenting, this suggests significant inflow or outflow disease requiring additional imaging with duplex ultrasound 1
• Avoid placing the blood pressure cuff directly over the stent site in the early post-procedure period to prevent thrombosis 3