혈관질환의 측정방법

인제대학교 부산백병원 순환기내과

김 동 수

ABI (ankle-brachial index)

• C.C : Intermittent claudication at 100 m

onset : 5years ago

• PHx. :

- HTN(+) 10년전진단

- Both renal artery stenosis 로 5개월전

PTRA with stenting

# Case : 조 0 춘 (M/67)

Abdominal angio CT(5개월전)

Both renal angiogram(5개월전)

Both renal artery stenting(5개월전)

ABI (before stenting)

RT : ABI 1.07 : Moderate

arterial stiffness is

suspected.

LT : ABI 0.91 : Moderate

arterial stenosis is

suspected.

Pelvic & Lower extremity Angio CT

PTA with stenting

(8×100mm, 7×40mm)

ABI (after stenting)

RT : ABI 1.11 : Arterial

stiffness is suspected.

LT : ABI 1.15 : Arterial

stiffness is suspected.

Age 50-69 years and smoking or diabetes

Age ≥ 70 years

Leg pain with exertion

Abnormal results on vascular examination of leg

Coronary, carotid, or renal arterial disease

Measure ankle-brachial index

Index > 1.30 Index 0.91-1.30 Index ≤ 0.90

Pulse-wave recording

Toe-Pressure measurement

Duplex USG

Measure ABI after treadmill test

Normal result:

no-peripheral

arterial disease

Abnormal

result

Normal post-exercise ABI:

no peripheral arterial

disease

Decreased

Post-exercise ABI

Evaluate other causes of

leg symptoms

Peripheral arterial disease

Evaluation of patients in Whom peripheral arterial disease is suspected

Ankle Brachial Index

• The most useful noninvasive test for evaluating at –risk patients for intermittent claudication.

• The ratio of SBP at the ankle to that in the arm.

• Serve as a surrogate measure of systemic atherosclerosis in the elderly and is one of the best predictors of CV events in these patients.

Pulse volume recording wave

morphology in plethysmography

정상

경한말초동맥질환

진행된말초동맥질환

ABI (ankle-brachial index)측정

Measurement of the ankle brachial index(ABI). PT,

posterior tibial artery; DP, dorsalis pedis artery.

Severity of Intermittent Claudication According

to Ankle-Brachial Index

Any ratio < 0.90 is diagnostic of peripheral arterial disease, with

a >95% sensitivity and specificity, except in diabetic patients and

elderly patients with arterial calcification, where vessel

noncompressability invalidates the ABI.

ABI Measurement:

Equipment

• Instrumentation:

- Hand-held 5 to 10 MHz ultrasound Doppler

device

• Cuffs:

- The same cuffs used for measurement of

arm BP should be used at the ankle.

- Cuff with bladder sizes appropriate for limb

circumference(width; >40%)

• Automatic device, the form PWV/ABI

Hand-held 5 to 10 MHz ultrasound Doppler device

Right dorsalis pedis artery

Right posterior tibial artery

Automatic device, the form PWV/ABI

Colin, Co., Ltd., Komak, Japan

VP-2000

ABI Measurement:

Method

• The patient should be strictly supine for at least 5

minutes before testing.

• Arm as well as ankle pressure should be taken

with the Doppler device.

• Ideally, both right and left arm pressures should

be measured and the higher one used.

• Ideally, both dorsalis pedis and tibialis posterior

pulses should be measured in each leg.

The suggested sequence of measurement

• Pressure 1: Right arm, left arm; take highest reading

• Pressure 2: Right dorsalis pedis

• Pressure 3: Right tibialis posterior

• Pressure 4: Arm with higher reading as determined

for Pressure 1

• Pressure 5: Left dorsalis pedis

• Pressure 6: Left tibialis posterior

• Pressure 7: Arm with higher reading as determined

for Pressure 1

Calculate ABI ratios

• Right dorsalis pedis:

pressure 2 / pressure 1

• Right tibialis posterior:

pressure 3 / pressure 4

• Left dorsalis pedis:

pressure 5 / pressure 4

• Left tibialis posterior:

pressure 6 / pressure 7

재현성이 있고 정확한 측정을 위한 방법

• Cuff를 deflation 시에 Doppler signal이처음들리는시점에압력을측정

• Cuff는적어도 arm SBP levels 의 20mmHg이상까지 inflation한다.

• Cuff 는 2mmHg/second 로서서히 deflation 한다.

• Doppler system은 brachial artery나 radial artery에서 arm SBP를측정할때사용한다.

Recommended action to take

after ABI testing

• ABI< 0.50 : refer for SVA and start IRFM

• ABI> 0.50 and < 0.90 : repeat within 3 months.

If it is confirmed to be;

- < 0.90, start IRFM and determine ABI annually

- 0.90, repeat every 2 to 3 years

• ABI 0.90 : repeat ABI every 2 to 3 years

• If ankle pressure is > 300mmHg , 75mmHg above arm pressure or the ABI is >1.3 : repeat within 3 months incompressible ankle artery due to medial calcification