DETECTION OF ATHEROSCLEROSIS BY ANKLE BRACHIAL INDEX: EVALUATION OF PALPATORY METHOD VERSUS ULTRASOUND DOPPLER TECHNIQUE

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

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.
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.

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