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Dr. Andrew Rynne

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Does abnormal ankle brachial index confirm the presence of peripheral arterial disease?

Answered by
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Dr. Lekshmi Rita Venugopal

General & Family Physician

Practicing since :2012

Answered : 2787 Questions

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Posted on 3 days ago in Veins and Arteries
Question: Hello....I have alleged mild to moderate peripheral artery disease that has caused claudication when walking in my calves, as diagnosed by an ABI bracchial index...But then. 4 years later, I was also diagnosed with moderate to severe spînal stenosis leading to neurogenic intermittend claudication due to compression of a root nerve on both sides of L5, S1. I understand that the latter condition can mimic results on an ABI tests and cause false readings. In addition, can compression of the micro-vessels of a nerve root going down two legs also cause confusion and inaccuracies with the arterial ultra-sound tests of arteries? I had a nerve block injection of the nerve root and the pain created was exactly like the pain I experience upon walking. I am confused as to what pain is caused by what condition, and could the vascular PAD be less than originally thought ? A vascular surgeon stated that my neurogenic condition was more predominant than my vascular one. I do not smoke, eat well, walk 4, 5 times a week for 40 minutes each time, cholesterol is 1.51 mmol, CRP is low.
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Answered by Dr. Lekshmi Rita Venugopal 2 hours later
Brief Answer:
Abnormal ankle brachial index is indicative of peripheral artery disease

Detailed Answer:

Hello,

Abnormal ankle brachial index is confirmative of presence of peripheral arterial disease and is not caused by nerve compression. Peripheral vascular disease and lumbar stenosis is commonly co-resistant especially in individuals above 65 years as in your case.

As your vascular surgeon mentioned, the neurological clarification must be predominant cause for the leg pain. However, abnormal Ankle brachial index confirms there is also underlying vascular disease.

It is really reassuring that you are on right track in management of PAD. Continue eating healthy, exercising regularly, and crestor. Your cholesterol is also well controlled which is very good. I would like to add that starting an antiplatlet medication like Aspirin or Clopidogrel is beneficial is managing and preventing further progression of PAD. Please discuss this with yiur treating physician.

Hope this answers your question. Please let me know if you need further clarification.

Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Lekshmi Rita Venugopal 45 minutes later
I am sorry but you are wrong doctor...there is a paper entitled: The validity of ankle-brachial index for the differential diagnosis of peripheral arterial disease and lumbar spinal stenosis in patients with atypical claudication
XXXXXXX
This article has been cited by other articles in PMC.

Neurogenic claudication can cause false positives on the ABI....so I would suggest you look this article up. Thank you!


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Hi again - I did not mean to be rude. But a vascular surgeon told me that I had more NIC than PAD after viewing the MRI of my spine, and HIS technician even told me that NIC can mimic PAD on ABI test and give a false positive, when actually it is the NIC that affects the ABI (he did not see this article). I can exist with PAD (I have no choice, I do have it) but I do not believe it is as significant as the ABI indicated, and that the NIC is much more significant (confirmed by two neurologists and one vascular surgeon). But the treatment is still the same for both: walking, walking and walking...I take Crestor = 5 mg. for PAD plus aspirin daily. Nerve blocks work at times for NIC, but not always. Epidural Injections also work, as do lumbar endoscopic dissections at L5, S1. The pain I am experiencing when walking is neurogenically-caused and not vascular-caused since the only relief I have is to sit. It is also very pronounced when I stand and that is LSS, not PAD... Thanks doctor, but as you well know, there are many variables in any medical test. XXXX, M.A. Cheers!


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Answered by Dr. Lekshmi Rita Venugopal 4 minutes later
Brief Answer:
Ankle Brachial index have sensitivity and sensitivity

Detailed Answer:

Hello,

If you read the article completely, there are only 4 patients who had false positive results which is statistically inconclusive that presence of lumbar stenosis will interfere with ankle-brachial index testing. The data is not sufficient enough to come to such a conclusion.

On the other hand, in the same study itself, the high sensitivity and specificity of the ankle-brachial index testing are reflective of the confidence with which we can predict peripheral vascular disease with ABI.

The article concludes that ankle-brachial index is very predictive of PAD. The 4 patients who got false positive results are not statistically significant. There can be many errors in which the study was conducted, measurements taken, interpreted etc which can lead to such variation.

The current diagnostic guidelines consider abnormal ABI index as caused by PAD, even in patients with concomitant neurological claudication.

ABI index testing is a screening test which is predictive of PAD. If you need definite confirmation of peripheral vascular disease, a CT angiogram can provide confirmation.

Hope I have answered your query. Let me know if I can assist you further.

Thank you.

Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician


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Brief Answer:
Continue current treatment regimen

Detailed Answer:

Hello,

No worries. You were not rude in any way. I appreciate that you took the time to share the article with me. I am really impressed with your interest in knowing more about your condition and taking care of your health.

As your vascular surgeon mentioned, definitely the neurological claudication will be the predominant problem in your case. Pain worsening on standing is more pointing towards neurological claudication itself. Since I do not have information about the exact result of your Ankle Brachial index, I cannot give you an opinion on the degree of Peripheral vascular disease, which can range from mild to severe. Mild cases of PAD usually will not contribute to much pain or discomfort.

The important thing is that you are currently on the right treatment track, whether it be neurological, vascular or both present concomitantly.

The end goal is to live pain-free. I suggest that you continue the current diet, treatment, and exercise regime. Loose weight if needed which can greatly ease the pain. Physiotherapy can also be considered for neurological claudication.

Continue what you are doing now and keep up the good work.

Hope I have answered your query. Wishing you good health.

Thank you.

Regards,
Dr. Lekshmi Rita Venugopal
General & Family Physician


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Above answer was peer-reviewed by : Dr. Prasad
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