ABI Diagnosis and Management of Peripheral Arterial Disease

Diagnostic Accuracy of ABI

The European Society of Cardiology recommends ABI as the first-line noninvasive test for screening and diagnosis of peripheral arterial disease (PAD), with sensitivity ranging from 68% to 84% and specificity from 84% to 99% when using the Doppler method 1, 4
The American College of Cardiology states that the resting ABI has been validated as a first-line test against various imaging methods, with areas under the ROC curve of 0.87-0.95 for Doppler-based ABI measurements 5, 6
The American College of Cardiology recommends that ABI results should be standardized and reported as: abnormal (≤0.90), borderline (0.91-0.99), normal (1.00-1.40), or noncompressible (>1.40) 4, 3

The American College of Cardiology indicates that duplex ultrasound is indicated as a first-line imaging method to confirm PAD lesions after ABI screening has been performed 2, 7
The American College of Cardiology suggests that Doppler ultrasound is particularly valuable for anatomical characterization of PAD lesions and guidance for optimal revascularization strategy 2, 8
The American College of Cardiology recommends that in cases of noncompressible arteries (ABI >1.40), alternative methods such as Doppler waveform analysis or pulse volume recording are indicated 2, 4

The American College of Cardiology recommends that for patients with incompressible ankle arteries, toe-brachial index (TBI) should be measured instead of ABI 4, 9
The American College of Cardiology suggests that in patients with exertional limb pain but normal or borderline resting ABI, exercise treadmill ABI testing should be performed to evaluate for PAD 4, 7
Both European and American guidelines agree that ABI is the initial test of choice, with Doppler ultrasound serving as a secondary diagnostic tool 2, 7

The European Society of Cardiology states that proper training improves reproducibility of ABI measurements, with experienced physicians achieving better results 1