Comparative Analysis of Novel Invasive Ankle Brachial Index Versus Traditional Ankle Brachial Index in Outpatients with Critical Limb Ischemia
Description
BACKGROUND: Ankle Brachial Index (ABI) is an established non-invasive diagnostic tool used for identification and prognostication of peripheral arterial disease (PAD). Retrograde tibial arterial access (RTA) angiography allows for a refined “invasive” ABI measurement, which substitutes the invasive distal pedal artery pressures as the numerator of the ABI value. This study aims to compare the traditional ABI to this novel “invasive” ABI measurement.
METHODS: A retrospective analysis of outpatient lower extremity endovascular procedures from 2018 to 2022 was performed of angiographically confirmed multi-level PAD with 100% occlusion at the superficial femoral artery(SFA)/popliteal artery level and in all three infra-popliteal arteries. “Invasive” ABI was defined as the ratio of the intra-arterial dorsal pedal pressure to the non-invasive brachial artery systolic pressure.
RESULTS: Of the initial cohort of 6,724 patients, the final study cohort consisted of 57 patients; average age 74 years, 33 males, and 24 African American. All patients had concomitant SFA/popliteal and 3-vessel infra-popliteal artery 100% occlusion. Diabetes mellitus (DM) and chronic kidney disease (CKD) were present in 34 patients, 18 patients were current smokers, and 54 patients presented with Rutherford Class 4-6. The mean traditional ABI was 0.59 ± 0.040, which was significantly higher than the invasive ABI of 0.40 ± 0.024, with a mean difference of 0.20 ± 0.27 (p < 0.01). Significant difference between traditional and invasive ABI were noted within subgroups of DM and/or CKD (p < 0.01) and those with a smoking history (p < 0.01).
CONCLUSION: Traditional ABI significantly overestimates peripheral arterial perfusion compared to ‘invasive’ ABI, in a cohort studying multi-level PAD with 100% occlusion in both the SFA/popliteal and infra-popliteal levels. This difference is found to be significantly more pronounced in populations with DM/CKD, and smoking.
Citation Information
Yee, Kess; Wutawunashe, Caleb; Tan, Darren; Kwan, Tak; and Siu, Henry, "Comparative Analysis of Novel Invasive Ankle Brachial Index Versus Traditional Ankle Brachial Index in Outpatients with Critical Limb Ischemia" (2026). Office of Research DMU Research Symposium. 36.
https://digitalcommons.dmu.edu/researchsymposium/2025rs/2025abstracts/36
Comparative Analysis of Novel Invasive Ankle Brachial Index Versus Traditional Ankle Brachial Index in Outpatients with Critical Limb Ischemia
BACKGROUND: Ankle Brachial Index (ABI) is an established non-invasive diagnostic tool used for identification and prognostication of peripheral arterial disease (PAD). Retrograde tibial arterial access (RTA) angiography allows for a refined “invasive” ABI measurement, which substitutes the invasive distal pedal artery pressures as the numerator of the ABI value. This study aims to compare the traditional ABI to this novel “invasive” ABI measurement.
METHODS: A retrospective analysis of outpatient lower extremity endovascular procedures from 2018 to 2022 was performed of angiographically confirmed multi-level PAD with 100% occlusion at the superficial femoral artery(SFA)/popliteal artery level and in all three infra-popliteal arteries. “Invasive” ABI was defined as the ratio of the intra-arterial dorsal pedal pressure to the non-invasive brachial artery systolic pressure.
RESULTS: Of the initial cohort of 6,724 patients, the final study cohort consisted of 57 patients; average age 74 years, 33 males, and 24 African American. All patients had concomitant SFA/popliteal and 3-vessel infra-popliteal artery 100% occlusion. Diabetes mellitus (DM) and chronic kidney disease (CKD) were present in 34 patients, 18 patients were current smokers, and 54 patients presented with Rutherford Class 4-6. The mean traditional ABI was 0.59 ± 0.040, which was significantly higher than the invasive ABI of 0.40 ± 0.024, with a mean difference of 0.20 ± 0.27 (p < 0.01). Significant difference between traditional and invasive ABI were noted within subgroups of DM and/or CKD (p < 0.01) and those with a smoking history (p < 0.01).
CONCLUSION: Traditional ABI significantly overestimates peripheral arterial perfusion compared to ‘invasive’ ABI, in a cohort studying multi-level PAD with 100% occlusion in both the SFA/popliteal and infra-popliteal levels. This difference is found to be significantly more pronounced in populations with DM/CKD, and smoking.
