Ankle Brachial Index (ABI)
Feb 17, 2015
It is amazing that so few Canadians have heard of the A.B.I. exam when it is so prevalent in the USA.
(For those that have never heard of it, it is a simple exam that uses a doppler and Sphygmomanometer, and records the systolic pressures at the four extremities to indicate any form of ischemia present in a person.)
EARLY SCREENING
Statistics state that every 7 minutes in Canada, someone dies from heart disease or stroke. So why are we not screening patients regularly, for vascular disease and preventing Peripheral Arterial Disease (P.A.D.)? There are many factors that play into this issue but one very obvious fact is; the A.B.I. exam is not common practice in the Canadian physician office where early diagnosis is most likely. This could be due to physician reimbursement or possibly the education and understanding of the A.B.I. exam. Our most common approach in Canada to P.A.D. is reactionary rather than proactive due to the typical process. When vascular disease is suspected, you are referred to a lab for further testing but there is very little, if any, proactive screening for P.A.D..
THE FALLOUT
In the absence of screening, patients with vascular disease are experiencing symptoms and arriving at the Canadian Hospitals for the diagnosis and treatment. At the point when they are symptomatic, the vascular disease has likely progressed to a point that the patient requires medical intervention. The result is additional pressure on our already overburdened hospital system and in some cases, amputations or even mortality. Vascular diseases often fall under the silent killer term because the patient does not always experience the symptoms prior to heart attack or stroke.
WHAT CAN BE DONE
The A.B.I. can be performed by Canadian hospitals in the clinics and emergency services. The exam is very simple and uses equipment that is commonly available in the department already. It provides a quick screening to those that potentially are at risk with an exam that is as simple as taking a blood pressure reading. Additionally, all clinic associated with the "at risk" population should perform this basic exam.
Wound Care should perform this exam prior to any compression stocking being used as the stocking can further complicate the wound, should P.A.D. exist.
WHAT IS REQUIRED
Contrary to popular belief, you can perform the A.B.I. with very little investment. A basic exam only requires a doppler with an 8MHz probe and a Sphygmomanometer (BP cuff). There are more advanced options available that will calculate and record the findings as well a document the exam for reimbursement but the basic A.B.I. uses equipment found commonly in most departments of a hospital or clinic. You can download an A.B.I. chart for free by clicking here. The exam consists of four systolic reading taken distal to the occlusion at the Ankle and Brachial.
WHERE CAN THIS BE USED
- Emergency room screening
- Diabetic Clinics
- Vascular Clinics
- Post Surgical follow up
- Wound care
- Physician office
- much more