Ankle Brachial Pressure Index (ABPI)

Your healthcare assistant asks for your advice on carrying out an ABPI on a patient with leg ulceration. Which ONE of the following pieces of advice below is the SINGLE MOST appropriate?

• The ABPI represents the highest recorded systolic pressure recorded in the ipsilateral arm over the systolic pressure in the affected leg

• The ABPI represents the highest recorded systolic pressure recorded in the affected leg over the highest recorded systolic pressure in either arm

• An ABPI cannot be done by a healthcare assistant

• The ABPI represents the highest recorded systolic pressure recorded in the affected leg over the systolic pressure in the ipsilateral arm

• The ABPI represents the highest recorded systolic pressure recorded in the two arms over the highest recorded systolic pressure in the affected leg

The ABPI is the ratio of the highest recorded systolic pressure recorded in the affected leg / highest recorded systolic pressure in either arm (i.e. detecting reduced pressure in distal leg vessels)

• Normal: 0.92 - 1.3 (majority of people having a ratio between 1 and 1.2)

• >1.3 usually indicative of non-compressible blood vessels

• <0.9 indicates some arterial disease (>0.5 and <0.9 may be associated with intermittent claudication)

Compression stockings

• Apply pressure from outside veins to squeeze blood in veins back up the legs. AKA elastic compression hosiery. Check ankle-brachial pressure index (ABPI) first. Closed toe or open toe (if painful toes, large feet, preference): Compression stockings (CKS), Compression hosiery and garments (BNF)

• Class 1 (Light), 2 (Medium), 3 (Strong). If person cannot tolerate preferred compression try the next level down

Indications and strength of compression

• Varicose veins (class 1 or 2 stockings depending on severity)

• Varicose eczema (class 1 or 2 stockings)

• Lipodermatosclerosis (class 2 stockings, or 3 if response to class 2 inadequate)

• Venous thromboembolism or prevention of post-thrombotic syndrome (class 3 stockings, or 2 if these are poorly tolerated)

• Superficial thrombophlebitis (class 1 or 2) - but debate about usefulness of compression for this condition