Variation of method for measurement of brachial artery pressure significantly affects ankle-brachial pressure index values.
BACKGROUND
Mmeasurement of ankle brachial pressure indices (ABPI) is important in the assessment of patients with peripheral vascular disease.


METHODS
Thirty-one hospitals with a vascular surgeon were selected at random. A telephone questionnaire was completed to assess the method used for the measurement of ABPI. Following the survey, 14 patients with peripheral vascular disease had their ABPI measurement done by two observers, a pre-registration house officer and a clinical nurse practitioner. Observers were blinded to their own and each other's results. Brachial systolic pressures were obtained using a DINAMAP(TM)(Critikon, Tampa, U.S.A.) automated blood pressure monitor, the Korotkoff method (12 cm cuff, parallel wrap) and an 8 MHz Doppler probe (Huntleigh) and sphygmomanometer. Ankle systolic pressures were obtained using the Doppler probe. The results were analysed using the Wilcoxon signed rank test.


RESULTS
The survey demonstrated that at the majority of centres with vascular laboratories the brachial artery systolic pressures were measured using a Doppler probe. In contrast, at centres where the house officers performed the routine measurements, over 60% used the Korotkoff method to obtain this reading. One in four nurse practitioners used the Korotkoff method. When the ABPI values were calculated, the DINAMAP produced significantly higher median values than the Korotkoff (0.79 vs 0.72, p=0.003) and Doppler methods (0.79 vs 0.70, p<0.0001). The nurse had a higher median ABPI value of 0.76 compared with the doctor (0.71, p=0.01).


CONCLUSIONS
This study shows that measurement of ABPI varies in different vascular units. The technique for ABPI measurement should be standardised.
Jeelani
N U
NU
Academic Department of Vascular Surgery, University Hospital, Nottingham.
Braithwaite
B D
BD
Tomlin
C
C
MacSweeney
S T
ST
D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods; D001916:Brachial Artery / Q000503:physiopathology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests