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Hi all

does an ABI reading of 180/140~1.3 warrant further investigation? assuming no signification hx like diabetes etc and nil observable sign of PVD

Feel free to comment plz

 

Speak to colleagues depending where you are - if your in a hospital try and get hold of someone in the vascular team and go through the pts hx very quickly, if in the community have a quick chat witht he GP on how they would like to proceed.

I would go for a further look, something must have made you suspicious in the first place to make you do an ABPI, and 1.3 is a high reading and is suggesting calcification of the vessels - A standard referal would be win win really, you either find something that needs to be treated or confirm that there is nothing to worry about at the moment.

Good luck

 

With a High ABI, over 1.3 my next step is to do a Toe-Brachial index. Obviously all of these tests need to be kept in context with a full Hx including smoking.

 

Refer back to GP to arrange a duplex scan
A TBI will give some info, but as you haven't established a possible etiology that is what I would do

 

A high ABI, by definition, is suggestive of calcification of the tunica intima.

This is usually benign, and may or may not be realted to atheroma. If there is a Monkenberg's pattern on plain films taken for other reasons, there may be underlying metabolic syndrome, and probable cardiac vessel changes.

The bottom line is this: can you palpate pulses? What do the arterial signals sound like (biphasic or better?)? Is there any claudication? And finally, is there a femoral bruit?

If these are all within normal limits, then monitor. Additional investigations will add nothing. Advise the GP of these findings, and if there is a gradual reduction in pedal pulses over time and some claudication pattern, perhaps do a Duplex then.

I routinely pay scant attention to elevated ABIs in the context of normal pulses.

LL

 

Thanks LL, I was going to ask Stephen why he would like a duplex scan in the absence of claudication symptoms. I was also of the understanding that monkbergs sclerosis, whilst providing continued patent vessels in the short term that there would be little use of a duplex.

In short the presence of an incompressible artery with a high ABI points towards there not being a significant stenosis.