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Medical Using Ankle Brachial Index to evaluate Cardiovascular Risk

  1. Jul 9, 2008 #1

    berkeman

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    I saw this pretty interesting article today:

    more.... http://www.medicalnewstoday.com/articles/114271.php

    Here is more info on how to obtain the ABI:
    more... http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=5393&nbr=3696#s22

    I'm pretty good at taking my own brachial BP.... Wonder if I can reach to take my ankle BP... :blushing:
     
  2. jcsd
  3. Jul 9, 2008 #2

    Moonbear

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    I was wondering how many people could take an accurate ankle BP? I wouldn't even know how to start. I'm also thinking that from a clinical perspective, one's patients might look at you a bit strangely if you suggested you were going to take their blood pressure on their ankle. :uhh:

    I guess what the bottom line is saying is that if you have arteries occluded enough to restrict circulation to your feet, thus lowering ankle BP, it's probably a good sign you're at risk for cardiovascular disease? If so, wouldn't other frequently reported symptoms remain good predictors, such as constantly cold feet, ankle edema, and things like that?
     
  4. Jul 10, 2008 #3

    berkeman

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    I get the impression that they like the ABI because it's quantitative. It does appear to take some practice to take, though. I just took mine, and got a bit over 1.1, but I wasn't supine, obviously. Foot up on my desk at work (luckily nobody walked by while I was doing it...). I used the diaphram of my stethoscope, and the best listening position seemed to be on the dorsalis pedis artery, just proximal to the split to the lateral and medial plantar arteries. It's definitely a lot bonier place than taking a brachial BP, though. It almost seemed like it was hard to fully occlude the dorsalis pedis artery, but I have pretty lean ankles. I wonder if a little pedal adema would help to occlude the artery more easily with the cuff...
     
  5. Jul 10, 2008 #4

    Moonbear

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    Huh? The lateral and medial plantar arteries branch off the posterior tibial artery. The dorsalis pedis artery branches off the anterior tibial artery.

    Which is easier to compress with a BP cuff, the anterior or posterior tibial artery? My guess would be the posterior, because you'd be able to compress it between the cuff and bone, while the anterior tibial is in a groove that seems somewhat protected by the tibia itself. I'm not sure though. Can you get good sounds on the posterior tibial artery? That's the one running posterior to the medial malleolus (for the non-anatomists, that would be the big bump on the inside of the ankle and toward the back side of it). I can feel a pulse point there if you find a space about midway between the ankle and calcaneal tendon (achilles' tendon).

    At least I can sit here poking around my ankles and feet in my office and still call it part of my job. :biggrin: The students are dissecting feet next week, so perfect timing.
     
  6. Jul 10, 2008 #5

    berkeman

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    Ack, sorry. I misread this diagram:

    http://www.eorthopod.com/images/ContentImages/ankle/ankle_anatomy/ankle_anatomy_arteries02.jpg

    Thanks for the correction.

    I was listening just above the branch to the lateral tarsal artery. I could hear the occluded flow okay, but had trouble completely occluding the vessel.

    I'll try getting to my posterior artery tonight at home (looks too weird with me sitting here in the office. I think you're right about the anterior artery -- it definitely was not shutting off the way I expected.

    Thanks Moonbear. Looks like I'm going to have to go looking for volunteers for this one...
     
  7. Jul 10, 2008 #6

    berkeman

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