The ankle–brachial index (ABI) post exercise is claimed to play a complementary role in the diagnosis or exclusion of intermittent claudication (IC). The interobserver variability of ABI measurements at rest and post exercise in patients with typical symptoms of IC is the subject of this study with emphasis on ABI post exercise. ABI at rest and post exercise were measured in both legs of 20 patients with typical symptoms of IC. After 15 minutes of rest these measurements were repeated by another observer. Analysis according to Bland–Altman was performed on 40 paired leg measurements at rest and 40 paired leg measurements post exercise. The average ABI at rest for the first observer was 0.84 (standard deviation ±0.18) and for the second was 0.84 (±0.17). Post-exercise averages were 0.73 (±0.25) and 0.74 (±0.27), respectively. The standard deviation of the ABI difference between observers was 0.08 at rest and 0.15 post exercise. The interobserver variability of the ABI was 10% at rest and 21% post exercise. The interobserver variability post exercise is an important given when rules are defined about how the ABI post exercise translates into a more reliable and objective diagnosis of IC.
1 Sigvant B Wiberg-Hedman K Bergqvist D . A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. J Vasc Surg2007; 45: 1185–1191.
2.
2 Jensen SA Vatten LJ Romundstad PR Myhre HO . The prevalence of intermittent claudication. Sex-related differences have been eliminated. Eur J Vasc Endovasc Surg2003; 25: 209–212.
3.
3 Meijer WT Hoes AW Rutgers D Bots ML Hofman A Grobbee DE . Peripheral arterial disease in the elderly: The Rotterdam Study. Arterioscler Thromb Vasc Biol1998; 18: 185–192.
4.
4 Doobay AV Anand SS . Sensitivity and specificity of the ankle–brachial index to predict future cardiovascular outcomes: a systematic review. Arterioscler Thromb Vasc Biol2005; 25: 1463–1469.
5.
5 Heald CL Fowkes FG Murray GD Price JF . Risk of mortality and cardiovascular disease associated with the ankle–brachial index: systematic review. Atherosclerosis2006; 189: 61–69.
6.
6 Hirsch AT Criqui MH Treat-Jacobson D . Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA2001; 286: 1317–1324.
7.
7 Klein S Hage JJ . Measurement, calculation, and normal range of the ankle–arm index: a bibliometric analysis and recommendation for standardization. Ann Vasc Surg2006; 20: 282–292.
8.
8 Stein R Hriljac I Halperin JL Gustavson SM Teodorescu V Olin JW . Limitation of the resting ankle–brachial index in symptomatic patients with peripheral arterial disease. Vasc Med2006; 11: 29–33.
9.
9 Caruana MF Bradbury AW Adam DJ . The validity, reliability, reproducibility and extended utility of ankle to brachial pressure index in current vascular surgical practice. Eur J Vasc Endovasc Surg2005; 29: 443–451.
10.
10 Atsma F Bartelink ML Grobbee DE van der Schouw YT . Best reproducibility of the ankle–arm index was calculated using Doppler and dividing highest ankle pressure by highest arm pressure. J Clin Epidemiol2005; 58: 1282–1288.
11.
11 Osmundson PJ O’Fallon WM Clements IP Kazmier FJ Zimmerman BR Palumbo PJ . Reproducibility of noninvasive tests of peripheral occlusive arterial disease. J Vasc Surg1985; 2: 678–683.
12.
12 Fowkes FG . Epidemiology of atherosclerotic arterial disease in the lower limbs. Eur J Vasc Surg1988; 2: 283–291.
13.
13 Fisher CM Burnett A Makeham V Kidd J Glasson M Harris JP . Variation in measurement of ankle–brachial pressure index in routine clinical practice. J Vasc Surg1996; 24: 871–875.
14.
14 Ray SA Srodon PD Taylor RS Dormandy JA . Reliability of ankle:brachial pressure index measurement by junior doctors. Br J Surg1994; 81: 188–190.
15.
15 Bonham PA Cappuccio M Hulsey T . Are ankle and toe brachial indices (ABI-TBI) obtained by a pocket Doppler interchangeable with those obtained by standard laboratory equipment. J Wound Ostomy Continence Nurs2007; 34: 35–44.
16.
16 Endres HG Hucke C Holland-Letz T Trampisch HJ . A new efficient trial design for assessing reliability of ankle–brachial index measures by three different observer groups. BMC Cardiovasc Disord2006; 6: 33.
17.
17 Beckman JA Higgins CO Gerhard-Herman M . Automated oscillometric determination of the ankle–brachial index provides accuracy necessary for office practice. Hypertension2006; 47: 35–38.
18.
18 Holland-Letz T Endres HG Biedermann S . Reproducibility and reliability of the ankle–brachial index as assessed by vascular experts, family physicians and nurses. Vasc Med2007; 12: 105–112.
19.
19 Jeelani NU Braithwaite BD Tomlin C MacSweeney ST . Variation of method for measurement of brachial artery pressure significantly affects ankle–brachial pressure index values. Eur J Vasc Endovasc Surg2000; 20: 25–28.
20.
20 Matzke S Franckena M Alback A Railo M Lepantalo M . Ankle brachial index measurements in critical leg ischaemia – the influence of experience on reproducibility. Scand J Surg2003; 92: 144–147.
21.
21 Kaiser V Kester AD Stoffers HE Kitslaar PJ Knottnerus JA . The influence of experience on the reproducibility of the ankle–brachial systolic pressure ratio in peripheral arterial occlusive disease. Eur J Vasc Endovasc Surg1999; 18: 25–29.
22.
22 Stoffers J Kaiser V Kester A Schouten H Knottnerus A . Peripheral arterial occlusive disease in general practice: the reproducibility of the ankle–arm systolic pressure ratio. Scand J Prim Health Care1991; 9: 109–114.
23.
23 Stoffers HE Kester AD Kaiser V Rinkens PE Kitslaar PJ Knottnerus JA . The diagnostic value of the measurement of the ankle–brachial systolic pressure index in primary health care. J Clin Epidemiol1996; 49: 1401–1405.
24.
24 Feringa HH Bax JJ van Waning VH . The long-term prognostic value of the resting and postexercise ankle–brachial index. Arch Intern Med2006; 166: 529–535.
25.
25 Carter SA . Response of ankle systolic pressure to leg exercise in mild or questionable arterial disease. N Engl J Med1972; 287: 578–582.
26.
26 Bland JM Altman DG . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet1986; i: 307–310.
27.
27 De Graaff JC Ubbink DT Legemate DA de Haan RJ Jacobs MJ . Interobserver and intraobserver reproducibility of peripheral blood and oxygen pressure measurements in the assessment of lower extremity arterial disease. J Vasc Surg2001; 33: 1033–1040.
