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

Abstract

Objective: We compared three commonly used methods of ankle/brachial index (ABI) calculation to determine their relative association with objective measures of leg functioning in peripheral arterial disease. Method: The study design was cross-sectional; the setting was an academic medical center. The participants were 244 men and women, aged 55 years and older, with and without peripheral arterial disease, from a noninvasive vascular laboratory and a general medicine practice. The main outcome measures were walking velocity and endurance, measured with the 4-m walk and the 6-minute walk, respectively. Three methods of ABI calculation were assessed: Using the highest arterial pressure within each leg (method 1), using the lowest pressure in each leg (method 2), and averaging the dorsalis pedis and posterior tibial pressures within each leg (method 3). For each method, we established the prevalence of peripheral arterial disease. We then used regression analyses to identify the ABI calculation method most closely associated with leg functioning. The ABI with the greatest statistical significance and largest regression coefficient was considered most closely associated with leg functioning. Results: Peripheral arterial disease prevalence ranged from 47% when method 1 was used to 59% when method 2 was used. When the right and left legs were compared, the leg with the lower ABI, as identified through use of method 3, was most associated with leg functioning. Within the leg with the lower ABI, method 3 was more closely associated with 6-minute walk distance (regression coefficient = 811.5 feet per 1 unit ABI; P < .001) than method 1 or method 2. Conclusion: The lower ABI, determined by averaging the dorsalis pedis and posterior tibial arterial pressures in each leg, is most predictive of walking endurance and walking velocity in peripheral arterial disease.