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Ankle Brachial Index (ABI) Test: How to Perform - YouTube
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welcome to a Stanford medicine 25 video
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on ankle brachial index hi I'm John
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Cooke I'm a professor of medicine in the
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division of cardiovascular medicine here
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at Stanford and today I'm going to show
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you how to detect proof our tool disease
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in the office setting using the ankle
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brachial index which is simply a measure
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of ankle pressure divided by the
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pressure at the arm the brachial
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pressure about 8 million people in the
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country with profe arterial disease but
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only about 30% have been diagnosed but
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with a simple handheld Doppler and a
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blood pressure cuff measurements at the
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ankle and at the arm can give you an
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ankle brachial index to tell you whether
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or not the person in your office has
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prefer our Childers ease everyone over
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the age of 60 and anyone over the age of
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50 that's diabetic or smoker should have
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this test done to determine if they have
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prior to these because we have life and
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limb saving medical therapies for these
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individuals like ACE inhibitors and
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statins and antiplatelet agents and even
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beta blockers can be used in patients
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with prior to disease so let's get
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started so for the ankle brachial index
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we need a handheld Doppler and we also
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need some ultrasonic gel and we need
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blood pressure cuff we want the patient
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in a dimly lit a quiet room for about 10
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minutes relaxed so the blood pressure
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stabilizes okay
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so what we're going to do first is
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measure the pressure at the arm and
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we're going to use the same technique to
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measure pressure at the arm that we're
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going to use to measure pressure at the
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ankles so I'm putting the blood pressure
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cuff around the arm right now you want
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it to be snug and now I'm going to put
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some ultrasound gel right here in the
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antecubital space over the brachial
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artery so my fingers are on the brachial
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artery there having done that now I can
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listen for the signal with my handheld
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Doppler
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no that's a nice signal
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it's a normal triphasic pulse waveform
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that we're hearing with our Doppler out
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okay now what we're going to do is we're
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going to blow up the blood pressure cuff
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until we no longer hear a signal okay
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we're going to gradually release the
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pressure gradually release the pressure
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until we hear the signal again okay he's
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got a blood pressure of 100 millimeters
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systolic
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so that becomes our denominator for the
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ankle brachial index now there are two
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vessels that were interested in in
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measuring the ankle brachial index so
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two vessels in the foot
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one is the dorsalis pedis which is right
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about here where my fingers the
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posterior tibial is right behind the
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medial malleolus if you can't feel the
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dorsalis pedis bilaterally it could be
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normal that could be a normal finding
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but you should always be able to feel a
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posterior tibial artery if you can't
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feel the posterior tibial artery that's
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always abnormal so once again you apply
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the blood pressure cuff and in this case
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we're going to be applying it right
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above the Millea lie again you want snug
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and you'll put the gel right behind the
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medial malleolus and the over the dorsum
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of the foot so let's just take a listen
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to the waveforms here so that's a very
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nice pulse waveform strong biphasic and
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that's normal in an adult and let's just
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take a listen over the posterior tibial
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nice pulse waveform there now
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let's check the pitot pressure
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okay I'd blown the cuff up and I'm
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slowly releasing it and that was about
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110 millimeters of mercury that roar
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that you just heard that was venous
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return I'll actually demonstrate that
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this is the arterial signal you can hear
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that I'm going to squeeze the foot and
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you'll hear the venous return moving
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past that Doppler transducer that's when
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it's returned well we'll talk about of
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the venous exam at another time but one
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can determine if someone has a venous
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obstruction or venous insufficiency we
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using this handheld Doppler now I've
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shown you how to do the posterior tibial
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pulse waveform I get the pressure there
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you do the same thing over the anterior
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tibial you do that for both pedal pulses
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and each extremity and then what is done
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to create the ankle brachial index is
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you take the highest of the brachial
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pressures that you've measured and that
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becomes your denominator the numerator
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is the highest ankle pressure in the
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right leg and the highest ankle pressure
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that you've measured in the left leg leg
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to give you the right and the left a B
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is respectively sometimes you'll find
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that the pressures are slightly
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different between the anterior tibial
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and the posterior tibial artery and by
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convention we express the higher those
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two pressures over the brachial pressure
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to get the ankle brachial index for that
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foot and we calculate the ankle brachial
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index for each each foot to conclude
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with the example in our video the
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patient's highest right ankle pressure
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was 110 which is divided by the highest
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of the blood pressures on both
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arms which was 100 giving the right
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ankle brachial index of 1.1 an ankle
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brachial index of 1 to 1.4 is normal
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whereas a value of 0.9 to 1 is
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acceptable neither require any
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intervention a value of 0.8 to 0.9
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suggest some arterial disease and
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treatment of risk factors is advisable a
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value of 0.5 to 0.8 suggest moderate our
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trill disease where a value of less than
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0.5 suggests severe arterial disease
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either category should be referred to a
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vascular specialist and finally a value
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greater than 1.4 can be an indication of
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calcification or vessel hardening which
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also should be referred this has been a
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Stanford medicine 25 video on ankle
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brachial index thanks for watching the
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preceding program is copyrighted by the
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Board of Trustees of the Leland Stanford
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junior University please visit us at
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med.stanford.edu
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