title: Atypical leg symptoms: does routine measurement of the ankle brachial pressure index (ABPI) in primary care benefit patients?
abstract: Background: Managing patients with atypical leg symptoms in primary care can be problematic. Determining the ankle brachial pressure index (ABPI) may be readily performed to help diagnose peripheral arterial disease, but is often omitted where signs and symptoms are unclear.Question:Does routine measurement of ABPI in patients with atypical leg symptoms aid management increase satisfaction and safely reduce hospital referral?Methodology:Patients with atypical leg symptoms but no skin changes or neurological symptoms underwent clinical review and Doppler ABPI measurement (suspicious finding ≤ 1.0). Testing was performed by the same doctor (study period: 30 months). Patient outcomes were determined from practice records, hospital letters and a telephone survey.Results: The study comprised 35 consecutive patients (males:N= 15), mean age 64 years (range: 39-88). Presentation included pain, cold feet, cramps, irritation and concerns regarding circulation. Prior to ABPI measurement, referral was considered necessary in 10, not required in 22 and unclear in 3. ABPI changed the referral decision in 10 (29%) and confirmed the decision in 25 (71%). During the study, 10 (29%) patients were referred (9 vascular, 1 neurology). Amongst the vascular referrals, significant peripheral arterial disease has been confirmed in six patients. A further two patients are under review and one did not attend. To date, lack of referral in patients with atypical leg symptoms but a normal ABPI has not increased morbidity. Current status was assessed by telephone review in 16/35 (46% contact rate; mean 18 months, range 2-28). Fifteen patients (94%) appreciated that their symptoms had been quickly and conveniently assessed, 8/11 (73%) with a normal ABPI were reassured by their result and in 8/11 symptoms have resolved.Discussion/Conclusion:APBI conveniently aids management of atypical leg symptoms by detecting unexpected peripheral arterial disease, avoids /confirms the need for referral, reassures patients and guides reassessment. This study suggests ABPI should be used more widely.
authors.affiliation: Eastmead Surgery, Ealing CCG . Greenford , UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Oesterling
authors.affiliation: Kingston Hospital NHS Trust , Kingston upon Thames , UK.
authors.forename: Amun
authors.initials: A
authors.lastname: Kalia
authors.affiliation: Ridgeway Surgery, Harrow CCG , North Harrow , UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chetcuti
authors.affiliation: St Giles Medical , London , UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Walker
keywords: Atypical leg symptoms; Doppler assessment; ankle brachial pressure index (ABPI); leg pain; primary care