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Do ankle brachial index and pulse volume waveforms compare with the Ultrasound Duplex Scan for identifying Peripheral Arterial Disease?

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To compare the sensitivity, specificity and overall accuracy of an automated ankle-brachial index (ABI) and pulse volume waveform (PVR) with the Ultrasound Duplex Scan (UDS) for identifying Peripheral Arterial Disease (PAD).

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200 patients referred for UDS of lower limb arteries at two Medical Physics departments in the UK underwent an automated ABI and PVR measurement using a device utilising volume plethysmography followed by a UD Scan. PAD was recorded for automated ABI if <0.9 (and noted if >1.30), PVR’s if graded mild/moderate/severe and with a haemodynamically significant stenosis or occlusive disease with the UDS. A result of PAD or NO PAD was recorded for each patient and each method. The outcome measure for this study was the agreement and overall accuracy between the automated ABI and UDS results and the PVR and UDS results.


Of the 200 patients recruited 65% were male, 35% female with an overall mean age of 67 years (range 25-90 (SD 12.38)). 26.7% had DM, 36.7% had CHD, and 28.9% were smokers. 38% were found to have PAD using the gold standard UDS. Those with DM and PAD = 7%, CHD and PAD = 15% and smokers with PAD = 16.4%. The overall results indicated good agreement between ABI and UDS (sensitivity 85%, specificity 89% with overall accuracy 88%) and between PVR and UDS (sensitivity 97%, specificity of 89%, with overall accuracy 95%).


The combined use of the ABI and PVR within one device could enhance vascular assessment especially those with potentially calcified vessels and for treatment planning of leg and foot wounds. With its rapid assessment time, it also has the potential to be introduced into a primary care screening environment as a reliable tool for confirming symptomatic PAD and early identification of asymptomatic PAD.

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Correspondence to Jane Lewis.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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  • Peripheral Arterial Disease
  • Occlusive Disease
  • Ultrasound Duplex
  • Ankle Brachial Index
  • Significant Stenosis