title: Evaluation of cuff-wrapping methods for the determination of ankle blood pressure.
abstract: OBJECTIVE
  The ankle-brachial index, which is calculated by dividing ankle systolic blood pressure by brachial systolic blood pressure, is useful in diagnosing peripheral arterial disease. Consensus has not been reached, however, on a standard method for measuring ankle systolic blood pressure. This study evaluated two cuff-wrapping methods for measuring ankle systolic blood pressure, compared with intra-arterial pressure as a gold standard.
  
  
  METHODS
  Study participants were 24 consecutive adult patients who underwent surgery under general anesthesia at Kyoto Prefectural University Hospital in Japan between January and March 2002. Indirect ankle systolic blood pressure was measured in the posterior tibial artery using a Doppler device and two cuff-wrapping methods: spiral, and straight. Direct ankle systolic blood pressure was measured in the dorsalis pedis artery.
  
  
  RESULTS
  Mean difference in ankle systolic blood pressure between indirect and direct measurements (indirect minus direct) was 1.4 mmHg [standard deviation of the difference (SDd), 17.6 mmHg] with the straight method and -1.4 mmHg (SDd, 22.2 mmHg) with the spiral method. The limit of agreements (mean difference +/-2 SDd) and intraclass correlation coefficient between two observers were -17.6 to 20.1 mmHg and 0.94, respectively, for the straight method and -39.4 to 40.0 mmHg and 0.78, respectively, for the spiral method.
  
  
  CONCLUSIONS
  The straight method, the same cuff-wrapping method used for measuring brachial blood pressure, appears to represent a more suitable wrapping method because of better interobserver reproducibility. Accuracy and reproducibility of indirect ankle systolic blood pressure measurement, however, were not adequately improved by either of the wrapping methods.
authors.affiliation: Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahashi
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Mahbubur
authors.initials: M
authors.lastname: Rahman
authors.forename: Shigeru
authors.initials: S
authors.lastname: Okamoto
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Tsuguya
authors.initials: T
authors.lastname: Fukui
mesh_terms: D000328:Adult; D000368:Aged; D000842:Ankle / Q000098:blood supply; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000379:methods*; D001916:Brachial Artery / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D013599:Systole; D016909:Tibial Arteries / Q000502:physiology