11/13/24, 6\:50 PM Guide | Ankle–brachial pressure index (ABPI)

Ankle–brachial pressure index (ABPI)

Table of contents
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0\:00 5\:51

Background

The ankle-brachial pressure index (ABPI) is a non-invasive method of assessing peripheral arterial perfusion in the lower
limbs.
ABPI is a ratio composed of the blood pressure of the upper arm (brachial artery) and the blood pressure of the lower limb
(dorsalis pedis and the posterior tibial artery). This guide provides a step-by-step approach to performing ABPI measurement in
an OSCE setting.

Gather equipment

Gather the relevant equipment to perform ABPI measurement\:
Sphygmomanometer\: to assess blood pressure.
Doppler probe\: make sure to check the Doppler probe is functioning correctly.
Ultrasound gel

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
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Brie
i n y o u r a r m a n d a n k l e . T h i s w i l l i n v o l v e i n
p r o b e . I t s h o u l d n’ t b e p a i n f u l , b u t i t m a y f e e l a l i t t l e t i gh t t e m p o r a r i l y . I f y o u w a n t m e t o s t o p a t a n y p o i n t , j u s t l e t m e k n o w .
"
Gain consent to proceed with ABPI measurement.
Ask if the patient has diabetes\: individuals with diabetes often have calci
calci
of the ankle pressure (using a special toe cu
Ask the patient if they have any pain before continuing with the clinical procedure.
Position the patient so that they are lying on the examination couch\: if the patient has leg ulcers these can be covered in
sterile cling-

Measure ABPI

Measure the brachial pressure

1. With the patient lying on the examination couch, place the sphygmomanometer cu
brachial artery and position the Doppler probe on the brachial artery at a 45°
angle (medial to the biceps tendon in the
antecubital fossa).
2. In
slowly, noting the pressure at which you
being assessed.
3. Now repeat steps 1 and 2 on the right brachial artery to assess systolic pressure.
4. Record the higher of the two systolic readings when calculating ABPI.
Place the sphygmomanometer cu

Measure the ankle pressure

1. Place the sphygmomanometer on the left ankle and position the Doppler probe over the posterior tibial artery, which is
located posterior to the medial malleolus.
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2. In
slowly, noting the pressure at which you
being assessed.
3. Keep the sphygmomanometer in the same location but re-position the Doppler probe over the dorsalis pedis artery of the
left foot, which is located lateral to the extensor hallucis longus tendon.
4. Assess the systolic pressure in the dorsalis pedis artery of the left foot by repeating step 2.
5. Record the highest of the two pressures obtained from dorsalis pedis (DP) and the posterior tibial artery (PTA) for use when
calculating the left ABPI.
6. Repeat the same process on the right leg to calculate the right ABPI.
Place the sphygmomanometer on the ankle

Calculate ABPI

Left ABPI = (highest pressure of either left PTA or DP) ÷ (highest brachial pressure)
Right ABPI = (highest pressure of either right PTA or DP) ÷ (highest brachial pressure)
Erroneous results can occur due to\:
Incorrectly positioned cu
Irregular pulse (e.g. atrial )
Calci
ABPI
value
Interpretation
>1.3
0.8-1.3 Calci
ultrasound and angiography are advised to accurately assess perfusion.
No evidence of signi
0.5-0.79 Mild or moderate arterial disease\: typical presenting features include claudication
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\<0.5
Severe arterial disease\: typical presenting features include rest pain, ulceration and gangrene. This is also
known as critical limb ischaemia.
Calculating ABPI
Worked example
Right brachial artery\: 120 mmHg
Left brachial artery\: 125 mmHg
Right dorsalis pedis\: 80 mmHg
Right posterior tibial artery\: 75 mmHg
Right ABPI = 80/125 = 0.64 (moderate arterial disease)

To complete the procedure...

Explain to the patient that the procedure is now complete.
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Document the left and right ABPI results in the patient's notes.

Suggest further assessments and investigations

Peripheral arterial exam\: to assess for clinical signs of peripheral arterial disease.
Blood tests\: as part of a general assessment of vascular risk factors (e.g. serum cholesterol, HbA1c).
Further imaging\: such as duplex ultrasound or a CT/MRI angiogram.
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References

1. Mo Al-Qaisi, David M Nott, David H King, and Sam Kaddoura. (2009). Ankle Brachial Pressure Index (ABPI)\: An update for
practitioners. Vasc Health Risk Manag. 5, 833–841.
2. McDermott MM, Criqui MH, Liu K, Guralnik JM, Greenland P, Martin GJ, Pearce W (2000).
"Lower ankle/brachial index, as
calculated by averaging the dorsalis pedis and posterior tibial arterial pressures, and association with leg functioning in
peripheral arterial disease"
. J Vasc Surg. 32 (6)\: 1164–71
3. Gogalniceanu P, Pegrum J, Lynn W. (2015) Physical Examination for Surgeons – a guide to the MRCS OSCE. Cambridge
University Press, UK.

Reviewer

Mr Peter Gogalniceanu
Source\: geekymedics.com
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