Simplification of ankle-brachial-index measurement using Doppler-waveform classification in symptomatic patients suspected of lower extremity artery disease

Antoine Métairie, Quentin Tollenaere, Damien Lanéelle, Alexis Le Faucheur, Estelle Le Pabic, Loukman Omarjee, Guillaume Mahé, Antoine Métairie, Quentin Tollenaere, Damien Lanéelle, Alexis Le Faucheur, Estelle Le Pabic, Loukman Omarjee, Guillaume Mahé

Abstract

Objectives: Ankle-brachial index (ABI) is commonly used for screening lower extremity peripheral artery disease (PAD) according to the international guidelines. Arterial Doppler waveform recordings is a tool to diagnose and assess PAD severity. We hypothesized that ABI measurement could be simplified by measuring only the pressure where the best arterial flow is recorded. The aim of this study was to evaluate the concordance between ABI performed according to the American Heart Association guidelines (AHA-ABI) and ABI measured according to best arterial waveform (FLOW-ABI).

Design: This was a monocentric cross-sectional study.

Methods: We included patients with exertional limb symptoms suspected of PAD. Arterial Doppler waveforms and ABI were acquired on both lower extremities at the pedis and tibial posterior arteries. Each arterial waveform was classified using the Saint-Bonnet classification. Concordances were analyzed with the kappa coefficient (confidence interval 95%). Exercise PAD study was registered n° NCT03186391.

Results: In total, one hundred and eighty-eight patients (62+/-12 years and 26.8+/-4.5 kg/m2) with exertional limb symptoms were included from May 2016 to June 2019. On each extremity, FLOW-ABI had excellent concordance for the diagnosis of PAD with the AHA-ABI with a kappa of 0.95 (95% CI: 0.90, 0.99) in the right extremity and 0.91 (95% CI: 0.86, 0.97) in the left extremity.

Conclusion: There is almost perfect concordance between AHA-ABI and FLOW-ABI. Thus, ABI can be simplified into five pressure measurements instead of seven in patient suspected of PAD with exertional limb symptoms. The question remains in patients with chronic limb ischemia.

Keywords: Doppler waveforms; ankle-brachial index; claudicant; lower extremity artery disease; peripheral arterial disease.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Métairie, Tollenaere, Lanéelle, Le Faucheur, Le Pabic, Omarjee and Mahé.

Figures

Figure 1
Figure 1
Diagram flow of the study. This figure shows the selection process of the study. Patients were excluded if there were missing ABI and missing arterial Doppler waveform. ABI means ankle brachial index.
Figure 2
Figure 2
Distal pressures according to Doppler waveforms. This graph shows the mean arterial pressure (and the standard deviation) according to the Doppler waveform in each lower extremity artery from both legs. We can observe a trend of decreasing pressure with flow alteration. TPA, tibial posterior artery (RTPA,right TPA; LTPA, left TPA); DPA, dorsalis pedis artery (RDPA, right DPA; LDPA, left DPA).
Figure 3
Figure 3
Correlation plots for each lower extremity between AHA-ABI and FLOW-ABI. PAD means lower extremity peripheral artery disease. FLOW-ABI corresponds to the ABI calculated according to the best arterial flow. AHA-ABI corresponds to the ABI calculated according to the American Heart Association guidelines. (A) Relationship between AHA-ABI and FLOW-ABI for the right limbs. (B) Relationship between AHA-ABI and FLOW-ABI for the left limbs. (C) Relationship between AHA-ABI and FLOW-ABI for the right limbs with two different Doppler arterial waveforms. (D) Relationship between AHA-ABI and FLOW-ABI for the left limbs with two different Doppler arterial waveforms.

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