Why we do not stop at the ankle-brachial index
The ankle-brachial index compares blood pressure at the ankle with blood pressure at the arm. It is a useful screen, and it fails in exactly the patients who most need it to work. Stiff, calcified arteries do not compress under the cuff, so the reading comes back normal — or falsely high — while the artery beneath is severely diseased.
So every patient with suspected peripheral artery disease or a threatened limb gets a complete arterial duplex — aortoiliac through the pedal arteries, with waveform analysis that reads flow rather than the vessel wall. Calcium does not blind it.
What the study covers
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Inflow. The aorta and the iliac arteries in the pelvis.
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Outflow. The femoral and popliteal arteries in the thigh and behind the knee.
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Below the knee. The three tibial arteries — where the hardest disease lives.
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Below the ankle. The pedal arteries and the arch of the foot: the vessels that actually feed a wound. Why the foot’s arteries decide the wound →
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Arms. The subclavian and upper-extremity arteries, when an arm is symptomatic or a dialysis access is planned. →
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Pedal acceleration time (PAT). A foot-level measurement of how quickly flow rises with each beat.
PAT can be measured beside an open ulcer or after a toe amputation — situations where toe pressures and skin-oxygen measurements simply cannot be obtained. In one single-center series of 73 threatened limbs, every one of the 59 limbs that were saved showed a two-class improvement in PAT after revascularization, while the 14 limbs whose PAT did not improve went on to above-ankle amputation
Who should have one
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Leg pain with walking that eases with rest — or, just as often, no leg pain at all
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A foot or leg wound that is not healing →
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Rest pain in the foot, particularly at night
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Diabetes or chronic kidney disease with any foot symptom — the two conditions that most often defeat the ABI
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Before and after revascularization, and on surveillance afterward
When to call us — don’t wait for your next visit
A leg that loses its blood supply suddenly is an emergency, and a foot wound with infection can move quickly.
Call our office today if you notice:
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A wound with spreading redness, foul drainage, or new black tissue
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Foot pain at rest, or pain that wakes you at night and eases when you hang the foot off the bed
Call our office at (918) 943-5303 and tell us what’s changed — we’ll get you seen sooner, because catching these early often keeps a small problem from becoming a big one.
Go to the emergency room now, or call 911, if you have:
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A foot or leg that becomes suddenly cold, pale, numb, or painful
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An infection that is spreading quickly, or a fever with a wound
For referring providers — We perform complete arterial duplex including pedal imaging and PAT in our own vascular lab. When the first visit shows a blockage is likely, the ultrasound, the procedure, and the follow-up visit are scheduled before the patient leaves; we obtain authorization in the background, and threatened limbs move to the front of the schedule. Refer: (918) 943-5303 · fax (855) 312-3594.
Refer urgently: rest pain, tissue loss, or gangrene · Routinely: claudication, a non-healing wound, diabetes with a foot ulcer, or a normal ABI with symptoms that do not fit. Full referral guide →