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Vascular Medicine
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Falsely high ankle-brachial index predicts major amputation in critical limb ischemia

Antonio Silvestro

Angiology Division, Swiss Cardiovascular Center, Inselspital, Bern, Switzerland

Nicolas Diehm

Angiology Division, Swiss Cardiovascular Center, Inselspital, Bern, Switzerland

Hannu Savolainen

Vascular Surgery Division, Swiss Cardiovascular Center, Inselspital, Bern, Switzerland

Do-Dai Do

Angiology Division, Swiss Cardiovascular Center, Inselspital, Bern, Switzerland

Jolanda Vögele

Angiology Division, Swiss Cardiovascular Center, Inselspital, Bern, Switzerland

Felix Mahler

Angiology Division, Swiss Cardiovascular Center, Inselspital, Bern, Switzerland

Samuel Zwicky

Angiology Division, Swiss Cardiovascular Center, Inselspital, Bern, Switzerland

Iris Baumgartner

Angiology Division, Swiss Cardiovascular Center, Inselspital, Bern, Switzerland, iris.baumgartner{at}insel.ch

Falsely high ankle-brachial index (ABI) values are associated with an adverse clinical outcome in diabetes mellitus. The aim of the present study was to verify whether such an association also exists in patients with chronic critical limb ischemia (CLI) with and without diabetes. A total of 229 patients (74 ± 11 years, 136 males, 244 limbs with CLI) were followed for 262 ± 136 days. Incompressibility of lower limb arteries (ABI > 1.3) was found in 45 patients, and was associated with diabetes mellitus (p = 0.01) and renal insufficiency (p = 0.035). Limbs with incompressible ankle arteries had a higher rate of major amputation (p = 0.002 by log-rank). This association was confirmed by multivariate Cox regression analysis (relative risk [RR] 2.67; 95% CI 1.27-5.64, p = 0.01). The relationship between ABI > 1.3 and amputation rate persisted after subjects with diabetes and renal insufficiency had been removed from the analysis (RR 3.85; 95% CI 1.25-11.79, p = 0.018). Dividing limbs with measurable ankle pressure according to tertiles of ABI, the group in the second tertile (0.323 ≤ ABI ≤ 0.469) had the lowest amputation rate (4/64, 6.2%), and a U-shaped association between the occurrence of major amputation and ABI was evident. No association was found between ABI and mortality. In conclusion, this study demonstrates that falsely high ABI is an independent predictor of major amputation in patients with CLI.

Key Words: angioplasty • bypass surgery • cardiovascular disease • diabetes • outcome analysis

Vascular Medicine, Vol. 11, No. 2, 69-74 (2006)
DOI: 10.1191/1358863x06vm678oa
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