Incompressible ankle arteries predict increased morbidity and mortality in patients with an elevated ankle brachial index

Author:

Laivuori Mirjami1ORCID,Peltonen Essi2,Venermo Maarit1,Hakovirta Harri234ORCID

Affiliation:

1. Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Finland

2. Department of Surgery, University of Turku, Finland

3. Department of Vascular Surgery, Turku University Hospital, Finland

4. Department of Surgery, Satasairaala, Pori, Finland

Abstract

Objectives Patients with an elevated ankle brachial index (ABI) > 1.3 have a high burden of disease and poorer outcome compared to patients with a lower ABI. Previously differences between patients with ABI > 1.3 have not been studied in detail. The aim of this study was to analyze the morbidity and mortality of patients with ABI > 1.3. Methods ABI measurements were performed in the vascular laboratory of Turku university hospital 2011–2013. Patients with ABI>1.3 in at least one lower limb were included in the study and divided into 3 groups: At least one lower limb ABI 1.3–2.5 but both limbs <2.5 (group 1), one limb ABI ≥2.5 (group 2), both limbs ABI ≥ 2.5 (group 3). Results 534 patients were included in the study. The patients in groups 2 and 3 were more often female ( p < .001), older ( p < .001), had more diabetes ( p = .013), coronary artery disease ( p = .001) and chronic heart ( p = .010) and kidney failure ( p = .013) compared to patients in group 1. The survival of patients in group 2 and 3 was significantly poorer compared to the patients in group 1 (HR1.6, 95% CI 1.2–2.2, p = .002 and 1.7, 95% CI 1.2–2.3, p < .001, respectively). Overall and cardiovascular mortality was higher in groups 2 and 3 than group 1.39.5% of patients with incompressible ankle arteries (ABI ≥ 2.5) in both lower limbs had toe pressure (TP) <50 mmHg and a poorer survival compared to patients with a higher TP. Conclusions Patients with incompressible ankle arteries have significantly higher overall and cardiovascular mortality and a greater burden of disease compared to the patients with a measurable yet abnormally high ABI. TP is a useful diagnostic tool when ABI is immeasurably high. All patients with ABI > 1.3 should be considered as high cardiovascular risk patients.

Funder

Sydäntutkimussäätiö

The Finnish Foundation for Cardiovascular Research

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,General Medicine,Surgery

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