title: Ankle brachial index and pneumoplethysmographic pulse-volume recordings for detection of peripheral arterial disease.
abstract: BACKGROUND
  The measurement of the ankle-brachial index (ABI) is a straightforward method for the detection of atherosclerosis in the lower limbs. Pneumoplethysmographic pulse-volume recordings (PVR) investigations are supposed to be less valid. Thus we compared the sensitivity of ABI and PVR in detection of PAD and its improvement by combining both methods.
  
  
  METHODS
  122 consecutive patients admitted for PAD treatment were included. All patients (81 females; mean age 70 ± 15 years) had angiographic imaging of their peripheral arteries, a standardized personal interview and a determination of the ABI based on the highest (ABI high) and lowest (ABI low) ankle pressure. PVR parameters were oscillometric index (OI) and time to normalisation (TN) after exercise.
  
  
  RESULTS
  There was a small variation of ABI with different segmental manifestations of PAD. The OI did not vary with different segmental manifestations. TN was longest in iliac artery manifestation and got shorter with more distal manifestation. Correlation of TN and ABI high and ABI low was low. Sensitivity of ABI high in all legs was 78 %, but only 40 % in isolated crural manifestation. ABI low has higher sensitivities with 87 % in all legs, but a much lower specificity. Combining ABI and TN increases both sensitivity and specificity. The best sensitivity and specificity was seen using ABI low + TN in combination in all kinds of manifestations with 94 % and 96 %, respectively.
  
  
  CONCLUSIONS
  Combined assessment of ABI low and TN in post-exercise PVR seems to be a highly sensitive but also specific method to look for PAD compared to ABI high alone.
authors.affiliation: Innere Medizin II des Evangelischen Krankenhauses Castrop-Rauxel, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Jahn
authors.affiliation: Innere Medizin II des Evangelischen Krankenhauses Castrop-Rauxel, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Zimmermann
authors.affiliation: Department of Vascular Medicine, HELIOS Klinikum Krefeld, Germany.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Moysidis
authors.affiliation: Department of Vascular Medicine, HELIOS Klinikum Krefeld, Germany.
authors.forename: Knut
authors.initials: K
authors.lastname: Kröger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009991:Oscillometry; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D010991:Plethysmography / Q000379:methods*; D011237:Predictive Value of Tests; D011859:Radiography; D015203:Reproducibility of Results; D018608:Ultrasonography, Doppler
keywords: Peripheral arterial disease; ankle brachial index; pneumatic segmental oscillography