Ankle brachial index

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In medicine and the physical examination, the ankle brachial index is the "comparison of the blood pressure between the brachial artery and the posterior tibial artery. it is a predictor of peripheral arterial disease."[1]


The blood pressure at the posterior tibial artery can be measured by Doppler ultrasonography[2], palpation[3], or auscultation.[4]

Role in health care

Diagnosis of peripheral arterial disease

Accuracy of the ankle brachial index (ABI) using various methods
Study Patients Test Outcome Results
Sensitivity Specificity
Carmo, 2009[4]
Cross-sectional study
81 consecutive patients referred for arterograms of any region.
• 17% had peripheral arterial disease
ABI by auscultation Doppler ABI < 0.9 71% 91%
Migliacci, 2008[3]
Cross-sectional study
205 patients from 24 primary care physicians. Subjects has at least one major cardiovascular risk factor.
• 4% had peripheral arterial disease
ABI by palpation Doppler ABI < 0.9 88% 82%
Khan, 2006[2]
Systematic review
  ABI by Doppler ultrasonography Angiography 95% > 95%

Prediction vascular disease and mortality

A meta-analysis concluded that "measurement of the ABI may improve the accuracy of cardiovascular risk prediction beyond the FRS (Framingham risk score)".[5]


  1. Anonymous (2022), Ankle brachial index (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 2.0 2.1 Khan NA, Rahim SA, Anand SS, Simel DL, Panju A (February 2006). "Does the clinical examination predict lower extremity peripheral arterial disease?". JAMA 295 (5): 536–46. DOI:10.1001/jama.295.5.536. PMID 16449619. Research Blogging.
  3. 3.0 3.1 Migliacci R, Nasorri R, Ricciarini P, Gresele P (August 2008). "Ankle-brachial index measured by palpation for the diagnosis of peripheral arterial disease". Fam Pract 25 (4): 228–32. DOI:10.1093/fampra/cmn035. PMID 18567610. Research Blogging.
  4. 4.0 4.1 Carmo GA, Mandil A, Nascimento BR, et al (February 2009). "Can we measure the ankle-brachial index using only a stethoscope? A pilot study". Fam Pract 26 (1): 22–6. DOI:10.1093/fampra/cmn086. PMID 19022870. Research Blogging.
  5. Fowkes FG, Murray GD, Butcher I, et al (July 2008). "Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis". JAMA 300 (2): 197–208. DOI:10.1001/jama.300.2.197. PMID 18612117. Research Blogging.