In Lumbar Stenosis, ABI and TBI Needed for PAD Diagnosis

Ankle, toe brachial index needed for peripheral artery disease diagnosis in lumbar spinal canal stenosis

WEDNESDAY, June 29 (HealthDay News) -- In patients with lumbar spinal canal stenosis (LSCS) with or without normal arterial pulses, screening for peripheral artery disease (PAD) should include measuring the ankle brachial pressure index (ABI) and toe brachial pressure index (TBI), according to a study published in the July 1 issue of Spine.

Shiro Imagama, M.D., from the Nagoya University Graduate School of Medicine in Japan, and colleagues evaluated the reliability of PAD diagnosis in 201 patients with intermittent claudication and LSCS. The occurrence of PAD was assessed using ABI and TBI testing. Patients with ABI of 0.9 or less or TBI of 0.6 or less were diagnosed with PAD. The correlation between PAD occurrence and symptoms and physical findings including abnormal arterial pulses was assessed.

The investigators identified 52 patients with combined LSCS and PAD, of which 45 patients had normal ABI and were diagnosed by TBI tests alone. Many patients who had PAD also had risk factors for PAD; there was a significantly higher frequency of PAD in patients with hyperlipidemia. The frequency of PAD was also significantly higher in patients with abnormal pulses in the poplitea, posterior tibial, and dorsal pedis arteries, but the sensitivity of these tests for diagnosing PAD was relatively low (34, 60, and 68 percent, respectively).

"PAD screening can be conducted using ABI and TBI tests. Observation of the arterial pulse is necessary but not sufficient for PAD diagnosis, which indicates that PAD should not be excluded even if the arterial pulse is normal," the authors write.

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