Central European Journal of Medicine

, Volume 9, Issue 2, pp 325–331 | Cite as

Attempt to determine the restrictions of ankle — brachial index and usefulness of elevated anklebrachial index in patients treated on an internal medicine ward

  • Jarosław Biliński
  • Natalia Czyżniejewska
  • Jacek Budzyński
Research Article



The ankle-brachial index (ABI) is used in the screening diagnosis of peripheral artery disease (PAD). Lower limb ischemia is diagnosed if ABI≤0.9. However, persons with ABI>1.4 also suffer from leg ischemia. Not taking this into consideration may lead to diagnostic mistakes and an underestimation of cardiovascular risk.


This study addresses the analysis of clinical conditions related to an elevated ABI.


One hundred and twenty-two randomly chosen subjects over 50 were treated in internal medicine ward were studied using questionnaire and ABI determination.


Forty-four (34%) patients had elevated ABI>1.4 and in 23 (19%) subjects ABI was≤0.9. Patients with ABI>1.4, in comparison to individuals with 0.9<ABI≤ 1.4, presented significantly greater BMI, more atherosclerosis risk factors, more prevalent past stroke and angina pectoris. In comparison to patients with ABI≤0.9, they showed higher blood pressure and lower LDL cholesterol concentration. In the diagnosis of ABI>1.4, lack of palpable pulse in at least one lower limb artery had a sensitivity of 6.8%, specificity of 91%, PPV of 30%, NPV of 63.4%, a likelihood ratio positive 0.75 and for negative 1.02; pulse pressure above 55mmHg had similar low diagnostic yield, respectively: 36.4%, 71.8%, 42.1%, 66.7%, 1.29 and 0.89. In logistic regression only LDL value was a significant predictive factor for elevated ABI, but with a very low odds ratio value for separate increments.


In the diagnosis of lower limb ischemia and connected cardiovascular risk, ABI determination should be obligatory, besides atherosclerosis risk factors, peripheral pulse and pulse amplitude determination.


Ankle-brachial index Atherosclerosis risk factors Chronic limb ischemia Multisite atherosclerosis Angiology 


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Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Jarosław Biliński
    • 1
  • Natalia Czyżniejewska
    • 1
  • Jacek Budzyński
    • 2
    • 3
  1. 1.Student Scientific CircleCollegium Medicum UMKBydgoszczPoland
  2. 2.Department of Gastroenterology, Vascular Diseases and Internal Medicine, The Ludwik Rydygier Collegium Medicum in BydgoszczNicolaus Copernicus University in ToruńToruńPoland
  3. 3.Clinical Ward of Vascular and Internal DiseasesJan Biziel University Hospital No. 2 in BydgoszczBydgoszczPoland

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