Bilquis Akhtar, Saulat Siddique, Rafiq Ahmad Khan, Sibgha Zulfiqar


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.
Conclusion: Early diagnosis of PAD in primary care practice by manual palpation of foot arteries is a
reliable method to identify the population at risk and may lead to aggressive preventive therapies.
Keywords: Peripheral arterial disease, cardiovascular disease, risk factors, ankle blood pressure,
ankle brachial index.


Faxon DP, Fuster V, Libby P, Beckman JA, Hiatt WR,

Thompson RW, Topper JN Annex BA, Rundback JH,

Fabunmi RP, Robertson RM and Loscalzo J Atherosclerotic

Vascular Disease Conference. Writing Group III:

Pathophysiology. Circulation 2004;109:2617–25.

Lusis AJ. Atherosclerosis. Nature 2000;407:233–41.

Balkau B. Vary M. Eschwege E. Epidemiology of peripheral

arterial disease. J. Cardiovasc Pharmacol 1994;23(Suppl-3):S8–16.

Hirsch AT, Griqui MH, Jacobson DT, Regensteiner JG,

Greager MA, Olin JW. Peripheral arterial disease detection

awareness and treatment in primary care. JAMA


Vogt MT, McKenna M, Wolfson SK, Kuller LH. The

relationship between ankle brachial index, other atherosclerotic

disease, diabetes, smoking and mortality in older men and

women. Atherosclerosis 1993;101:191–202.

J Ayub Med Coll Abbottabad 2009;21(1)

Kenneth Ouriel. Detection of peripheral arterial disease in

primary care. JAMA 2001;286:1380–1.

Hiatt WR, Hoag S, Hamman RF. Effect of Diagnostic Criteria

on the prevalence of Peripheral Arterial Disease: The San Luis

Valley Diabetes Study. Circulation 1995;91:1472–9.

McDermott MM, Greenland PH, Liu K, Guralnik JM, Celic L,

Criqui MH. The ankle brachial index is associated with leg function

and physical activity. Ann Intern Med 2002;136:387–8.

Curb DJ, Kamal Masaki, Beatriz I, Rodriguez, Robert D,

Abbot, et al. Peripheral arterial disease and cardiovascular

factors in the elderly The Honolulu Heart Program.

Atherosclerosis, Thrombosis and Vascular Biology


Criqui MH, Fronek A, Klauber MR, Barrett-Connor E and

Gabriel S. The sensitivity, specificity and predictive value of

traditional clinical evaluation of peripheral arterial disease:

results from non invasive testing in a defined population.

Circulation 1985;71(3):516–22.

Powers KB, Vacek JL and Lee S. Noninvasive approaches to

Peripheral Vascular Disease. Postgraduate Medicine


Barnes RW. Noninvasive Diagnostic Assessment of Peripheral

Vascular Disease. Circulation 1991;83 (2suppl):120–7.

Blumenthal RS, Becker DM, Yanek LR, Aversano TR, Moy

TF, Kral BG, et al. Detecting occult coronary disease in a high

risk asymptomatic population. Circulation 2003;107:702–7.

Fowkes FGR, Housby E, Cawood EHH, Macintyre CCA,

Ruckley CV, Prescott RJ. Edinburgh artery study: prevalence

of asymptomatic and symptomatic peripheral arterial disease in

the general population. International Journal of Epidemiology


Federman DG, Bravata DM, Kirsner RS. Peripheral arterial

disease, a systemic disease extending beyond the affected

extremity. Geriatrics 2004;59:26–35.

Stoffers HEJ, Rinkens PELM, Kester ADM, Kaiser V,

Knottnerus JA. The prevalence of asymptomatic and

unrecognized peripheral arterial occlusive disease. Int J

Epidemiol 1996;25:282–90.

Stoffers HEJ, Kester ADM, Kaiser V, Rinkens P, Kittslaar

PJEHM, Knottnerus JA. Diagnostic value of the measurement

of the ankle brachial systolic pressure index in primary health

care. Journal of Clinical Epidemiology 1996;49(12):1401–5.

Leng GC, Fowkes FGR, Lee AJ, Dunber J, Housely E,

Ruckley CV. Use of ankle brachial pressure index to predict

cardiovascular events and death. Br Med J 1996;313:1440–3.

Ostergren J, Sleight P, Dagenais G, Danisa K, Bosch J, Oilong

Y, et al. Impact of ramipril in patients wth evidence of clinical

or sub clinical peripheral arterial disease. European Heart J


Bashir, Riyaz; Cooper, Christopher J. Evaluation and medical

treatment of peripheral arterial disease. Current Opinions in

Cardiology 2003;18(6):436–43.

Selvin E, Thomas P and Erlinger. Prevalence of and risk

factors for peripheral arterial disease in the United States.

Circulation 2004;110:738–43.


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