title: Detection of atherosclerosis by ankle brachial index: evaluation of palpatory method versus ultrasound Doppler technique.
abstract: BACKGROUND
  Peripheral Arterial Disease [PAD], a manifestation of systemic atherosclerosis, is highly prevalent both in community studies and in primary care practice. Estimation of ankle brachial index [ABI] by ultrasound Doppler is the standard screening method for the detection of atherosclerosis in PAD patients. A low ABI is associated with increased risk of stroke or transient ischemic attack, ischemic heart disease and lower extremity gangrene. Though prevalence is high, physician and patient awareness of the condition is low. Primary care physicians are not well versed with the use of Doppler. Initial cost of the equipment is another adverse factor in low income countries. Detection of ankle systolic pressure by palpatory method may offer a cheap, simple and useful alternative approach in office care settings for early detection of disease. This may lead to the use of risk reduction strategies to avoid significant future morbidity and mortality.
  
  
  METHODS
  The sample size of 230 participants was identified. Patients were divided into control (100 cases), high risk asymptomatic (100 cases) and symptomatic groups (30 cases). Ankle systolic pressure was measured by digital palpation of foot arteries and by the gold standard Doppler technique in all patients in the three groups. PAD was defined by an ABI of < 0.9.
  
  
  RESULTS
  In control group, mean +/- SD value of ABI was 1.0115 +/- 0.08167 by Doppler method versus 0.9923 +/- 0.08609 by palpatory method (p = 0.1), in high risk asymptomatic group, 0.9838 +/- 0.08878 versus 0.9608 +/- 0.10377 (p = 0.13) and in symptomatic group, 0.9302 +/- 0.14064 versus 0.9088 +/- 0.13274 (p = 0.12). Against the more precise Doppler method, palpatory method was equally good in detecting the PAD positive cases.
  
  
  CONCLUSIONS
  Early diagnosis of PAD in primary care practice by manual palpation of foot arteries is a reliable method to identitfy the population at risk and may lead to aggressive preventive therapies.
authors.affiliation: Department of Physiology, Punjab Postgraduate Medical Institute, Lahore, Pakistan. bilquisakhtarkhakwani@gmail.com
authors.forename: Bilquis
authors.initials: B
authors.lastname: Akhtar
authors.forename: Saulat
authors.initials: S
authors.lastname: Siddique
authors.forename: Rafiq Ahmad
authors.initials: RA
authors.lastname: Khan
authors.forename: Sibgha
authors.initials: S
authors.lastname: Zulfiqar
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index / Q000295:instrumentation / Q000379:methods*; D001161:Arteriosclerosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D001794:Blood Pressure; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D010173:Palpation; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013223:Statistics as Topic; D013599:Systole; D018608:Ultrasonography, Doppler