Ankle, Brachial Index (ABI)


Article Author:
Kaylan McClary


Article Editor:
Patrick Massey


Editors In Chief:
Dustin Constant
Donald Kushner


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Kyle Blair
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Daniyal Ameen
Altif Muneeb
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes
Komal Shaheen
Sandeep Sekhon


Updated:
6/26/2019 12:02:06 PM

Introduction

The ankle-brachial index (ABI) is a non-invasive tool for the assessment of vascular status. It consists of the ratio between the systolic blood pressure of the lower extremity, specifically the ankle, and the upper extremity. This ratio is a comparison of the resistance of the blood vessels with one of the primary factors being the diameter of the vessels. This diameter is narrowed either from internal factors (plaque, intimal tear) or external factors such as compression by soft tissues.

Anatomy

The ankle-brachial index is measured using three arteries: the brachial artery for the upper extremity, and the dorsalis pedis and or posterior tibial artery at the ankle.

Dorsalis pedis artery: The dorsalis pedis artery arises primarily from the anterior tibial artery and starts higher in the anterior compartment of the leg between the tibialis anterior and extensor hallucis longus (EHL). In the majority of cases, the vessel above the ankle passes under the EHL to reside between EHL and the extensor digitorum longus (EDL). Other variations include later crossing sites either at the ankle or distal.[1] Ranging the great toe can help identify the EHL for guidance about where to find the dorsalis pedis pulse, especially in a patient with faint pulses. Additionally, the artery can be traced proximally from the first dorsal metatarsal artery extending into the great toe web space or distally from the supplying artery.

Posterior tibial artery: The posterior tibial artery passes posterior to medial malleolus at the ankle between the tibialis posterior and flexor digitorum longus tendons.[2]

Brachial artery: The brachial artery is palpable medial to biceps tendon in the antecubital fossa.[3]

Indications

The ankle-brachial index has uses in screening, diagnosis, treatment, guidance, and prognosis. See the clinical relevance section for further information.

Contraindications

Deep vein thrombosis (DVT): The American Heart Association guidelines recommend avoiding compression of the extremity with known or suspected DVT due to concern for breaking and embolizing a thrombus.[4]

Severe leg pain: Performing ABI measurement requires significant pressure to be applied to the leg. Whether related to leg ischemia, fracture/swelling, or wounds, this procedure can cause significant pain for the patient.

Equipment

Manual Technique

Compression device[4]: Blood pressure cuff (sphygmomanometer).  The appropriate size is a “width at least 40% of the limb circumference”.

Pulse detection device: doppler or stethoscope

Automated Technique

Oscillometer[5]: Use regular cuff for calf diameter less than 35cm and large cuff for over 35 cm. Take note; there are limits to the use of an automated device as the device has difficulty reading low blood pressures. Also, there is a concern the value is less accurate as the device detects the point of maximum impulse, which is more consistent with the mean arterial pressure. 

Personnel

An ankle-brachial index is a tool that can be used by many medical providers, including physicians, nurse practitioners/physician extenders, and nurses. One study showed in general practice setting that nurses were the highest utilizer of this diagnostic tool.[6][7]

This tool plays a valuable clinical role across many specialties, including:

  • Medicine
  • Primary care
  • Vascular surgery
  • Plastic surgery
  • Trauma
  • Orthopedic surgery
  • Podiatry
  • Emergency medicine
  • Wound care

Preparation

  • Rest patient. Different guidelines suggest the patient should have a specific rest period before the assessment of ABI, ranging from 10 to 30 minutes.
  • Avoid nicotine. Studies show that smoking selectively affects the ankle but not the brachial systolic pressure resulting in artificially elevated values.[4]
  • Supine position. There is a documented increase in the ABI value by approximately 0.3 with sitting instead of the supine position.[8]
  • Quiet space: Avoid underestimating systolic pressure due to difficulty with the audibility of systolic sounds.
  • Supported limbs: Reduces motion, and the patient is more likely to be relaxed.
  • Cover wounds: Reduce the risk of contaminating wound or equipment.

Technique

Cuff Application Sites

Arm: Mid-arm

Ankle: Above level of malleoli

For the manual method, apply stethoscope or doppler to sites of brachial, dorsalis pedis, and posterior arteries as described in the anatomy section.

Inflate cuff 20 to 30mm Hg above the last heard sound then slowly release pressure. The first heart sound is the pressure that should be recorded as the systolic pressure at that site.

Order: The AHA suggests performing the order of measurements as follows: First arm, same side ankle (both PT and DP), opposite leg and opposite arm.[4]

 If there is a 10m Hg difference in the arm, it is recommended to recheck the initial arm to address the “white coat effect” of blood pressure measurement.[9]

Calculation: The calculation is the ratio of the systolic pressure at the ankle over the systolic pressure at the arm. The appropriate value to use for the systolic ankle pressure has been a subject of debate. The most commonly used is the highest value of the ankle values.[10] One study looked at alternative methods including averaging values, dorsalis pedis only, posterior tibial only, and lowest value.  This study suggests all have prognostic value. The difference is the “threshold” for abnormal values and varies slightly (0.87 to 0.95).

Complications

Studies demonstrate value variability based on experience as well as the same patient different days and between offices/ specialties.[11] One study suggests repeatability is the best using high ankle/highest arm.[12] A suggested minimal significant difference between recorded ABI values is 0.15. Also, consider training. About one-third of providers who reported performing procedure demonstrated “correct” use per study.[7]

Clinical Significance

Values

  • Normal: 0.9 to 1.4 [13]
  • High: greater than 1.4, typically indicative of vessel stiffening
  • Low:  less than 0.9 - narrowing of vessels
  • Non-measurable: Unable to occlude blood vessel at 300mmHg of pressure application.

Minimal variations in ABI value occur with race, sex, age, and height, but overall predictability of PAD similar amongst groups.[13][14]

Special considerations for the pediatric population: In early infancy, ABI values average lower values than adults (58% below 0.9); however, ABI reaches normal values after 12 months.[15] Studies support use in the pediatric population to reduce radiation exposure of more invasive tests with good reliability.[16]

In general, the variation in measurements is less in young, healthy individuals.

Clinical Uses

Peripheral arterial disease (PAD)

The AHA suggests considering evaluation in patients of age over 50 and smoker, patients with diabetes, or over age 70  for peripheral arterial disease.[4] In one screening study involving asymptomatic 50 years old patients; 20% were identified to have PAD.[17] One study suggested that providers in the general medical community use the information to initiate cardiovascular risk reduction interventions.[7] Peripheral arterial disease results suggest that ABI is better at detecting greater than 50% stenosis and proximal lesions better than distal lesions.[18] Both low and high ABI values have an independent association of cardiovascular events.[14] Also, abnormal ABI correlates with the risk of chronic kidney disease.[19]

Several studies have used ABI for prediction of additional risk due to low invasiveness and relative ease of performance to the test:

  • Studies show correlations of ABI less than 0.9 with increased risk for PVD, MI, renal disease, HTN.[20]
  • Lower ABI also associated with high carotid plaque score.[21]
  • There is a higher risk of recurrent stroke (HR 1.7) and vascular evens/ death (2.22).[22]

Ulcer management

Traditionally ABI was thought to have a role in wound healing. One study evaluating heel wounds showed ABI was not reliable for heel pressure sores.[23] Another study suggested that ABI is predictive of further need for amputation in diabetic wounds, but not in wound healing itself.[24] An ABI under 0.5 increased the likelihood of amputation by 40%.[25]

ABI is useful in the evaluation of critical limb ischemia. One management protocol suggests that in the setting of critical limb ischemia, a normal or inability to perform ABI warrants more invasive evaluation. If there is abnormality to the ABI, promote surveillance if no tissue loss/gangrene and revascularization if the case of tissue loss or gangrene.[26]

After revascularization, there is a correlation between change in ABI value and ulcer wound healing (ABI delta greater than or equal to 0.23, HR 1.87 for wound healing).[27]

For post-surgical healing

Surgical healing prediction:

  • ABI has been reported useful in total knee arthroplasty procedures. Lower ABI (less than 0.7) shows an increased chance of total knee arthroplasty failure.[28]
  • Patients with lower ABI more likely to have delayed healing when undergoing heart surgery.[29]
  • Evaluation of flap placement in foot/ankle trauma 0.9 to 1.2.[30]

Trauma

ABI has a role for initial evaluation and management of blunt trauma and knee dislocations as a method of assessing for vascular injury.[31][32][33][34] The widely used criteria is an ABI less than 0.9 as an abnormal value for knee dislocations. For low values (less than 0.9), further evaluation is warranted, including methods such as ultrasound, MRI, CT, and angiography. For values greater than 0.9, serial monitoring is the recommendation (48 to 72 hours).[35][36] ABI can provide correlation with physical exam monitoring, exhibiting good reliability (sensitivity ABI 49.5  % vs. ABI + exam 100%); however, if the two do not agree, further evaluation may be warranted.[37][38]

Claudication

Occult PAD in 20% of patients referred to orthopedic surgery for leg pain in patients over 50 years old.[17]

One study found that the value of the ABI was not necessarily predictive of current functional status, but there is prognostic value with a greater likelihood to have decreased in functional status over time with lower baseline values.[20][39]

Also, there are conditions associated with claudication unrelated to arterial disease. These conditions include functional popliteal syndrome,[40] and exercise-induced leg pain.[41] In these individuals, muscle hypertrophy of the soft tissues can lead to vessel occlusion, which is important to note/consider when evaluating a patient for exertional compartment syndrome as these patients would not be expected to improve after fasciotomy.

Enhancing Healthcare Team Outcomes

The use of ABI for patient care requires knowledgeable individuals who are trained to do so. Training is necessary for the full team of providers from the physicians, physician extenders, and nurses. One randomized control trial evaluated the optimal way to teach the ABI procedure to medical students. The study compared didactic versus experiential learning. Results showed that experiential learning significantly improved the ability to perform the test correctly accurately.[42] (Level 2 evidence - small randomized control trial.)

Performance, application, and interpretation of ABI require an interprofessional team approach, including physicians, specialists, and specialty-trained nurses, all collaborating across disciplines to achieve optimal patient results. [Level V]

Nursing Actions and Interventions

Performing ABI assessment does take time; estimated 15 minutes. As such, it will often fall on the duty of the nurse to perform the evaluation to assist in clinical flow.

For wound care providers, including nursing:

Guidelines exist for monitoring wound care application[7][43]:

  • Avoid compression dressing with ABI 0.5 and refer to the specialist/supervising provider
  • Values 0.5 to 0.8 apply low compression only
  • Greater than 0.8 may apply high compression

Nursing Monitoring

The key to nursing monitoring is establishing protocols for ABI.

An appropriate protocol for nursing monitoring should address the following three questions: Which values should I use? What periods to perform the test? When should I notify someone?  Routine trauma monitoring for injuries such as knee dislocations has been suggested at intervals of every 2 hours. This approach should consist of clinical assessment and determination if ABI is necessary at the same time with every clinical evaluation.  Other options include ABI at specific periods (i.e., a clinical exam every 2 hours and ABI every 4 hours) or only if there is a change in the clinical exam.


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Ankle, Brachial Index (ABI) - Questions

Take a quiz of the questions on this article.

Take Quiz
An ankle-brachial index (ABI) recording is requested for a patient. Several blood pressure readings are documented as follows: right arm brachial 135/92 mmHg, left arm brachial 140/93 mmHg, right leg dorsalis pedis 139/91 mmHg, posterior tibial 142/91 mmHg, left leg dorsalis pedis 146/89 mmHg, posterior tibial 141/88 mmHg. What is the most accurate ABI calculation for this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 30-year-old obese female presents to the emergency department after a reported right knee dislocation at a trampoline park which the first responders self reduced on the way to the hospital. The physical exam demonstrates a knee effusion and pain, limiting participation with motion evaluation. She has palpable dorsalis pedis and posterior tibial pulses which feel similar to the contralateral side. Sensation and mobility of ankle and foot are intact. Her ankle-brachial index (ABI) is measured to be 0.98 on the right side and 0.99 on the left side. What is the best next step in the evaluation or management of her vascular status after knee dislocation?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 71-year-old female presents for pre-op evaluation for management of a foot ulcer on the lateral aspect of her right foot. Her past medical history is significant for hypertension, hypothyroidism, diabetes, and a history of deep vein thrombosis. The ulcer on her right foot is nonpainful and has no active drainage or exposed bone. There is no significant erythema or swelling. She reports some new swelling to her left calf with no history of trauma. The provider prefers to perform an ankle-brachial index (ABI) screening routinely for patients. Which factor is a contraindication for use of ankle-brachial index as a pre-operative screening tool for this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 65-year-old male presents to the clinic for one year of lower left leg pain. He had no history of trauma. The pain starts with walking and improves with rest. There has been no redness or swelling. The pain is cramping in nature in his calves. He has had no associated numbness or tingling. He has a 30-pack-year history of smoking. Which of the following is the best initial test in the evaluation of this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 75-year-old female is screened with an ankle-brachial index (ABI) testing at her primary care appointment. An oscillometer is used, and recorded blood pressures show right arm 110/60 mmHg and right leg 90/55 mmHg. Which of the following best describes her risks compared to an individual with an ABI of 1.0?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Ankle, Brachial Index (ABI) - References

References

Yamada T,Gloviczki P,Bower TC,Naessens JM,Carmichael SW, Variations of the arterial anatomy of the foot. American journal of surgery. 1993 Aug;     [PubMed]
Azam M,Shaw PM, Anatomy, Bony Pelvis and Lower Limb, Tibial Artery 2019 Jan;     [PubMed]
Bains KNS,Lappin SL, Anatomy, Shoulder and Upper Limb, Elbow Cubital Fossa 2019 Jan;     [PubMed]
Aboyans V,Criqui MH,Abraham P,Allison MA,Creager MA,Diehm C,Fowkes FG,Hiatt WR,Jönsson B,Lacroix P,Marin B,McDermott MM,Norgren L,Pande RL,Preux PM,Stoffers HE,Treat-Jacobson D, Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012 Dec 11;     [PubMed]
MacDougall AM,Tandon V,Wilson MP,Wilson TW, Oscillometric measurement of ankle-brachial index. The Canadian journal of cardiology. 2008 Jan;     [PubMed]
Gibb MA,Edwards HE,Gardner GE, Scoping study into wound management nurse practitioner models of practice. Australian health review : a publication of the Australian Hospital Association. 2015 Apr;     [PubMed]
Davies JH,Kenkre J,Williams EM, Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening. BMC family practice. 2014 Apr 17;     [PubMed]
Xu Y,Xu W,Wang A,Meng H,Wang Y,Liu S,Li R,Lu S,Peng J, Diagnosis and treatment of traumatic vascular injury of limbs in military and emergency medicine: A systematic review. Medicine. 2019 May;     [PubMed]
Hettrick H, The science of compression therapy for chronic venous insufficiency edema. The journal of the American College of Certified Wound Specialists. 2009 Jan;     [PubMed]
Böhrer H,Schick M,Schönstedt R,Bach A, Marked decrease in arterial oxygen tension associated with continuous intravenous nifedipine administration. Anaesthesia. 1991 Oct;     [PubMed]
Le Bivic L,Magne J,Guy-Moyat B,Wojtyna H,Lacroix P,Blossier JD,Le Guyader A,Desormais I,Aboyans V, The intrinsic prognostic value of the ankle-brachial index is independent from its mode of calculation. Vascular medicine (London, England). 2019 Feb;     [PubMed]
Donnou C,Chaudru S,Stivalet O,Paul E,Charasson M,Selli JM,Mauger C,Chapron A,Le Faucheur A,Jaquinandi V,Mahé G, How to become proficient in performance of the resting ankle-brachial index: Results of the first randomized controlled trial. Vascular medicine (London, England). 2018 Apr;     [PubMed]
Królczyk J,Piotrowicz K,Chudek J,Puzianowska-Kuźnicka M,Mossakowska M,Szybalska A,Grodzicki T,Skalska A,Gąsowski J, Clinical examination of peripheral arterial disease and ankle-brachial index in a nationwide cohort of older subjects: practical implications. Aging clinical and experimental research. 2018 Dec 17;     [PubMed]
Rac-Albu M,Iliuta L,Guberna SM,Sinescu C, The role of ankle-brachial index for predicting peripheral arterial disease. Maedica. 2014 Sep;     [PubMed]
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. Journal of clinical epidemiology. 2005 Dec;     [PubMed]
Nicolaï SP,Kruidenier LM,Rouwet EV,Bartelink ML,Prins MH,Teijink JA, Ankle brachial index measurement in primary care: are we doing it right? The British journal of general practice : the journal of the Royal College of General Practitioners. 2009 Jun;     [PubMed]
Criqui MH,McClelland RL,McDermott MM,Allison MA,Blumenthal RS,Aboyans V,Ix JH,Burke GL,Liu K,Shea S, The ankle-brachial index and incident cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis). Journal of the American College of Cardiology. 2010 Oct 26;     [PubMed]
Katz S,Globerman A,Avitzour M,Dolfin T, The ankle-brachial index in normal neonates and infants is significantly lower than in older children and adults. Journal of pediatric surgery. 1997 Feb;     [PubMed]
Dean EM,Rogers K,Thacker MM,Kruse RW, Inter-observer reliability of the ankle-brachial index in a pediatric setting. Delaware medical journal. 2015 Mar;     [PubMed]
Hong JB,Leonards CO,Endres M,Siegerink B,Liman TG, Ankle-Brachial Index and Recurrent Stroke Risk: Meta-Analysis. Stroke. 2016 Feb;     [PubMed]
Bernstein J,Esterhai JL,Staska M,Reinhardt S,Mitchell ME, The prevalence of occult peripheral arterial disease among patients referred for orthopedic evaluation of leg pain. Vascular medicine (London, England). 2008 Aug;     [PubMed]
Semba M,Inui N, Inhibition of 12-O-tetradecanoylphorbol-13-acetate-enhanced transformation in vitro by inhibitors of phospholipid metabolism. Toxicology letters. 1990 Mar;     [PubMed]
Sonoda H,Nakamura K,Tamakoshi A, Ankle-Brachial Index is a Predictor of Future Incident Chronic Kidney Disease in a General Japanese Population. Journal of atherosclerosis and thrombosis. 2019 Apr 30;     [PubMed]
Crowell A,Meyr AJ, Accuracy of the Ankle-brachial Index in the Assessment of Arterial Perfusion of Heel Pressure Injuries. Wounds : a compendium of clinical research and practice. 2017 Feb;     [PubMed]
Wassel CL,Allison MA,Ix JH,Rifkin DE,Forbang NI,Denenberg JO,Criqui MH, Ankle-brachial index predicts change over time in functional status in the San Diego Population Study. Journal of vascular surgery. 2016 Sep;     [PubMed]
Brownrigg JR,Hinchliffe RJ,Apelqvist J,Boyko EJ,Fitridge R,Mills JL,Reekers J,Shearman CP,Zierler RE,Schaper NC, Performance of prognostic markers in the prediction of wound healing or amputation among patients with foot ulcers in diabetes: a systematic review. Diabetes/metabolism research and reviews. 2016 Jan;     [PubMed]
Wang Z,Hasan R,Firwana B,Elraiyah T,Tsapas A,Prokop L,Mills JL Sr,Murad MH, A systematic review and meta-analysis of tests to predict wound healing in diabetic foot. Journal of vascular surgery. 2016 Feb;     [PubMed]
Shishehbor MH,White CJ,Gray BH,Menard MT,Lookstein R,Rosenfield K,Jaff MR, Critical Limb Ischemia: An Expert Statement. Journal of the American College of Cardiology. 2016 Nov 1;     [PubMed]
Reed GW,Young L,Bagh I,Maier M,Shishehbor MH, Hemodynamic Assessment Before and After Endovascular Therapy for Critical Limb Ischemia and Association With Clinical Outcomes. JACC. Cardiovascular interventions. 2017 Dec 11;     [PubMed]
Alizargar J,Bai CH, Value of the arterial stiffness index and ankle brachial index in subclinical atherosclerosis screening in healthy community-dwelling individuals. BMC public health. 2019 Jan 15;     [PubMed]
Gad BV,Langfitt MK,Robbins CE,Talmo CT,Bono OJ,Bono JV, Factors Influencing Survivorship in Vasculopathic Patients. The journal of knee surgery. 2019 May 23;     [PubMed]
Taylor AJ,George KP, Ankle to brachial pressure index in normal subjects and trained cyclists with exercise-induced leg pain. Medicine and science in sports and exercise. 2001 Nov;     [PubMed]
Boffa GM,Faggian G,Buja G,Livi U,Bortolotti U,Stellin G,Razzolini R,Stritoni P,Mazzucco A,Thiene G, Coronary artery spasm in heart transplant recipients. The Journal of heart transplantation. 1989 Mar-Apr;     [PubMed]
Tsai J,Liao HT,Wang PF,Chen CT,Lin CH, Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction: patient selection and surgical refinement. Microsurgery. 2013 Jul;     [PubMed]
Ko SH,Bandyk DF, Interpretation and significance of ankle-brachial systolic pressure index. Seminars in vascular surgery. 2013 Jun-Sep;     [PubMed]
Perron AD,Brady WJ,Sing RF, Orthopedic pitfalls in the ED: vascular injury associated with knee dislocation. The American journal of emergency medicine. 2001 Nov;     [PubMed]
Mills WJ,Barei DP,McNair P, The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. The Journal of trauma. 2004 Jun;     [PubMed]
Klineberg EO,Crites BM,Flinn WR,Archibald JD,Moorman CT 3rd, The role of arteriography in assessing popliteal artery injury in knee dislocations. The Journal of trauma. 2004 Apr;     [PubMed]
Pardiwala DN,Rao NN,Anand K,Raut A, Knee Dislocations in Sports Injuries. Indian journal of orthopaedics. 2017 Sep-Oct;     [PubMed]
Medina O,Arom GA,Yeranosian MG,Petrigliano FA,McAllister DR, Vascular and nerve injury after knee dislocation: a systematic review. Clinical orthopaedics and related research. 2014 Sep;     [PubMed]
Lane R,Nguyen T,Cuzzilla M,Oomens D,Mohabbat W,Hazelton S, Functional popliteal entrapment syndrome in the sportsperson. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2012 Jan;     [PubMed]
Long B,April MD, What Is the Utility of Physical Examination, Ankle-Brachial Index, and Ultrasonography for the Diagnosis of Arterial Injury in Patients With Penetrating Extremity Trauma? Annals of emergency medicine. 2018 Apr;     [PubMed]
deSouza IS,Benabbas R,McKee S,Zangbar B,Jain A,Paladino L,Boudourakis L,Sinert R, Accuracy of Physical Examination, Ankle-Brachial Index, and Ultrasonography in the Diagnosis of Arterial Injury in Patients With Penetrating Extremity Trauma: A Systematic Review and Meta-analysis. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2017 Aug;     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Surgery-Podiatry Cert Medicine. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Surgery-Podiatry Cert Medicine, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Surgery-Podiatry Cert Medicine, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Surgery-Podiatry Cert Medicine. When it is time for the Surgery-Podiatry Cert Medicine board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Surgery-Podiatry Cert Medicine.