Ankle-to-Brachial Ratio Index Underestimates the Prevalence of Peripheral Occlusive Disease in Diabetic Patients at High Risk for Arterial Disease

Ankle-to-brachial ratio index (ABI) is a simple method recommended for screening and evaluating peripheral arterial occlusive disease (PAOD) severity in diabetic patients. However, it has been suggested that subclinical media artery calcification could falsely normalize ABI (1), and prevalence of effective arterial occlusive disease when arteries are not compressible is not clear (2). Therefore, defining clinically relevant peripheral arterial occlusion on an ABI threshold of <0.9 could lead to misclassifying many diabetic patients, especially in a population at high risk for PAOD and arterial calcification (age, kidney disease, and hypertension). We evaluated the accuracy of ABI in screening and evaluating PAOD in such a population. …