Falsely normalized ankle-brachial index despite the presence of lower-extremity peripheral artery disease: two case reports
Abstract Background The ankle-brachial index measurement is used for screening and diagnosis of lower-extremity peripheral artery disease and cardiovascular risk assessment. However, the value is occasionally unreliable since the oscillometric ankle-brachial index can be elevated and falsely normali...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-12-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-021-03155-z |
| _version_ | 1819238108590243840 |
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| author | Tatsuya Maruhashi Shogo Matsui Farina Mohamad Yusoff Shinji Kishimoto Masato Kajikawa Yukihito Higashi |
| author_facet | Tatsuya Maruhashi Shogo Matsui Farina Mohamad Yusoff Shinji Kishimoto Masato Kajikawa Yukihito Higashi |
| author_sort | Tatsuya Maruhashi |
| collection | DOAJ |
| description | Abstract Background The ankle-brachial index measurement is used for screening and diagnosis of lower-extremity peripheral artery disease and cardiovascular risk assessment. However, the value is occasionally unreliable since the oscillometric ankle-brachial index can be elevated and falsely normalized despite the presence of lower-extremity peripheral artery disease because of the incompressibility of infrapopliteal arteries at the ankle, potentially leading to a missed diagnosis of lower-extremity peripheral artery disease or underestimation of cardiovascular risk. Case presentation We report two cases of lower extremity peripheral artery disease with normal ankle-brachial index (a 76-year-old Asian man and a 66-year-old Asian man). In both cases, the ankle-brachial index was within the normal range (1.00–1.40) despite the presence of lower-extremity peripheral artery disease, whereas upstroke time at the ankle calculated from the pulse volume waveform simultaneously obtained by plethysmography during the ankle-brachial index measurement was prolonged (≥ 180 milliseconds). Diagnostic imaging tests revealed the presence of occlusive arterial disease in the lower extremity and severe calcification of infrapopliteal arteries. Conclusions In both cases, the oscillometric ankle-brachial index might have been falsely normalized despite the presence of lower-extremity peripheral artery disease because of calcified incompressible infrapopliteal arteries. Sole reliance on the ankle-brachial index value may lead to a missed diagnosis of lower-extremity peripheral artery disease or underestimation of cardiovascular risk. Upstroke time at the ankle was helpful for suspecting the presence of lower-extremity peripheral artery disease in both patients with normal ankle-brachial index. In addition to history-taking and vascular examination, upstroke time at the ankle should be carefully checked for accurate diagnosis of peripheral artery disease and cardiovascular risk assessment in patients with normal ankle-brachial index. |
| first_indexed | 2024-12-23T13:30:59Z |
| format | Article |
| id | doaj.art-6976d1d7e2944f6ba51db7db8356a33a |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-23T13:30:59Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-6976d1d7e2944f6ba51db7db8356a33a2022-12-21T17:45:10ZengBMCJournal of Medical Case Reports1752-19472021-12-011511610.1186/s13256-021-03155-zFalsely normalized ankle-brachial index despite the presence of lower-extremity peripheral artery disease: two case reportsTatsuya Maruhashi0Shogo Matsui1Farina Mohamad Yusoff2Shinji Kishimoto3Masato Kajikawa4Yukihito Higashi5Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine (RIRBM), Hiroshima UniversityDepartment of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima UniversityDepartment of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine (RIRBM), Hiroshima UniversityDepartment of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine (RIRBM), Hiroshima UniversityDivision of Regeneration and Medicine, Hiroshima University HospitalDepartment of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine (RIRBM), Hiroshima UniversityAbstract Background The ankle-brachial index measurement is used for screening and diagnosis of lower-extremity peripheral artery disease and cardiovascular risk assessment. However, the value is occasionally unreliable since the oscillometric ankle-brachial index can be elevated and falsely normalized despite the presence of lower-extremity peripheral artery disease because of the incompressibility of infrapopliteal arteries at the ankle, potentially leading to a missed diagnosis of lower-extremity peripheral artery disease or underestimation of cardiovascular risk. Case presentation We report two cases of lower extremity peripheral artery disease with normal ankle-brachial index (a 76-year-old Asian man and a 66-year-old Asian man). In both cases, the ankle-brachial index was within the normal range (1.00–1.40) despite the presence of lower-extremity peripheral artery disease, whereas upstroke time at the ankle calculated from the pulse volume waveform simultaneously obtained by plethysmography during the ankle-brachial index measurement was prolonged (≥ 180 milliseconds). Diagnostic imaging tests revealed the presence of occlusive arterial disease in the lower extremity and severe calcification of infrapopliteal arteries. Conclusions In both cases, the oscillometric ankle-brachial index might have been falsely normalized despite the presence of lower-extremity peripheral artery disease because of calcified incompressible infrapopliteal arteries. Sole reliance on the ankle-brachial index value may lead to a missed diagnosis of lower-extremity peripheral artery disease or underestimation of cardiovascular risk. Upstroke time at the ankle was helpful for suspecting the presence of lower-extremity peripheral artery disease in both patients with normal ankle-brachial index. In addition to history-taking and vascular examination, upstroke time at the ankle should be carefully checked for accurate diagnosis of peripheral artery disease and cardiovascular risk assessment in patients with normal ankle-brachial index.https://doi.org/10.1186/s13256-021-03155-zAnkle-brachial indexPeripheral artery diseaseInfrapopliteal arteryUpstroke timeDiabetes mellitusAtherosclerosis |
| spellingShingle | Tatsuya Maruhashi Shogo Matsui Farina Mohamad Yusoff Shinji Kishimoto Masato Kajikawa Yukihito Higashi Falsely normalized ankle-brachial index despite the presence of lower-extremity peripheral artery disease: two case reports Journal of Medical Case Reports Ankle-brachial index Peripheral artery disease Infrapopliteal artery Upstroke time Diabetes mellitus Atherosclerosis |
| title | Falsely normalized ankle-brachial index despite the presence of lower-extremity peripheral artery disease: two case reports |
| title_full | Falsely normalized ankle-brachial index despite the presence of lower-extremity peripheral artery disease: two case reports |
| title_fullStr | Falsely normalized ankle-brachial index despite the presence of lower-extremity peripheral artery disease: two case reports |
| title_full_unstemmed | Falsely normalized ankle-brachial index despite the presence of lower-extremity peripheral artery disease: two case reports |
| title_short | Falsely normalized ankle-brachial index despite the presence of lower-extremity peripheral artery disease: two case reports |
| title_sort | falsely normalized ankle brachial index despite the presence of lower extremity peripheral artery disease two case reports |
| topic | Ankle-brachial index Peripheral artery disease Infrapopliteal artery Upstroke time Diabetes mellitus Atherosclerosis |
| url | https://doi.org/10.1186/s13256-021-03155-z |
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