Smart ABI Test for PAD (Peripheral Arterial Disease), University Foot and Ankle Institute (2023)

Smart ABI Test for PAD (Peripheral Arterial Disease), University Foot and Ankle Institute (1)

Do you feel pain in your legs after walking or climbing stairs? Notice that one leg feels colder than the other, or maybe you feel ankle pressure or pain in your lower limbs?

These can be signs of a circulation problem that shouldn’t be ignored, as those are common symptoms of Peripheral Artery Disease (PAD) or Peripheral Vascular Disease (PVD).

University Foot and Ankle Institute offers a quick and easy test to determine if you have peripheral artery disease. Called an ankle-brachial index test (also known as a smart-ABI test), it is a simple blood pressure measurement in two places in your body that can determine if the circulation issue in your legs is PAD.

What is Peripheral Artery Disease (PAD)?

Peripheral artery disease (PAD) is a heart disease-related condition that affects the blood vessels outside the heart and brain, most commonly in the legs. It occurs when fatty deposits build up in the inner lining of arteries, causing them to narrow and harden. This restricts blood flow to the legs, leading to symptoms such as pain, cramping, numbness, weakness, and fatigue in the legs, especially during physical activity.

What is the difference between Peripheral Artery Disease and Peripheral Vascular Disease?

Since a Smart ABI test can detect both of these circulation conditions, let’s take a moment to explain the difference between these two conditions.

Peripheral artery disease (PAD) and peripheral vascular disease (PVD) are terms that are often used interchangeably, but they have some differences.

PAD specifically refers to a condition where there is a narrowing or blockage in the arteries that supply blood to the legs, feet, arms, or hands. This can lead to pain, numbness, or cramping in the affected limb, especially during exercise or physical activity. PAD is most commonly caused by atherosclerosis, a buildup of plaque or calcification in the arteries.

PVD, on the other hand, is a broader term that refers to any condition that affects the blood vessels outside of the heart and brain. This includes conditions that affect both arteries and veins. PVD can be caused by a variety of factors, including atherosclerosis, blood clots, and inflammation.

So, while PAD is a specific type of PVD that affects the arteries in the limbs, PVD encompasses a wider range of vascular conditions that affect the blood vessels outside of the heart and brain.

What are the Common Risk Factors for Peripheral Artery Disease?

PAD is most commonly caused by atherosclerosis, a buildup of plaque on the walls of arteries.

Some high-risk factors for PAD include:

  • Diabetes
  • Smoking (cigarette)
  • 50+ years old
  • High Blood Pressure
  • High Cholesterol
  • Obesity
  • Family History

What are the Common Symptoms of PAD?

Symptoms of PAD can include:

  • Cold lower extremities (the leg and foot)
  • Fatigue when walking
  • Numbness or weakness in the leg, cramping in the hips, thighs, or calf muscles after activity
  • Changes in skin color, shiny skin,
  • Slower hair and toenail growth on the affected leg
  • A weak pulse, or lack of pulse, in the legs or feet
  • Sores on the legs, feet, or toes that don’t heal
  • Arm pain when doing everyday tasks like writing
  • Erectile dysfunction.

What Happens if PAD is Left Untreated?

If left untreated, PAD (as well as peripheral vascular disease) can lead to serious lower extremity complications such as leg pain, ulcers, gangrene, and even amputation. As the PAD worsens, the patient’s pain will eventually occur at rest or when lying down.

The danger in PAD is that muscles and other tissues can’t function properly without enough blood flow to deliver nutrients and oxygen to them. Leg sores from PAD, and other leg injuries, simply can’t heal without the nutrients in the blood.

Without healing nutrients, those sores and injuries can develop gangrene. There is no cure for gangrene – tissue damaged by gangrene must be amputated – but there are treatments to keep it from getting worse. Fast treatment can keep gangrene from getting worse, but the best prevention is to diagnose and treat PAD before it advances.

How do we test for peripheral artery disease (PAD)?

Smart Ankle Brachial Index, also known as Smart ABI, was designed to make it easy for physicians to test patients who doctors suspect may have or are at risk for PAD.

The device is a non-invasive test and simply involves placing an inflatable cuff around the patient’s upper arm and ankle to get a number of blood pressure readings. What it does is calculate the differences between the arm and ankle pressures.

The machine uses a Doppler ultrasound device to test for blood flow by taking systolic blood pressure measurements from the blood pressure cuffs. The ABI value is easily calculated by the readings from the machine. The ABI value determines the level of blockage or narrowing in the arteries to diagnose PAD.

Once the test has been conducted, a report is created for our healthcare provider that includes intelligent, quantitative, and color-coded graphic scores that indicate a Normal, Borderline, or Severe risk for PAD.

After the first test, the patient’s information is saved in the software and serves as their baseline data. This allows the doctor to accurately track the patient’s trends over time to know if they are improving or worsening.

What are the advantages of our Smart ABI test?

  • It Is fast as it only requires a 5-minutes of the patient’s time.
  • It does not require further waiting time for test results from your healthcare provider.
  • Since the machine is in our office, it is very easy to schedule tests.
  • It uses safe Bluetooth wireless cuff technology for comfortable pulse volume recordings and volume plethysmography.
  • It can easily track patient improvements or declines over time.

How our Podiatrists Utilize Smart ABI to Help Test for PAD (Peripheral Arterial Disease)

Peripheral Arterial Disease can often lead to difficulty walking, pain in the extremities, slower healing, and even the loss of a limb. We use Smart ABI as part of our physical examination to test and accurately diagnose patients who could be at risk for PAD.

Currently, the American Heart Association, the experts in cardiovascular health care requests that all patients who could be at risk for PAD should be tested. The Smart ABI enables a short test that measures a patient’s Ankle Brachial Index or ABI. It also measures blood pressure in the ankle area, body mass index, and blood pressure in general.

How is PAD treated?

There is no outright “cure” for peripheral artery disease (PAD), but it can be managed and treated to alleviate symptoms, slow down its progression, and reduce the risk of complications. Treatment for PAD may include:

Lifestyle changes:

  • Quitting smoking
  • Eating a healthy diet, low in saturated and trans fats
  • Exercising regularly
  • Maintaining a healthy weight
  • Managing blood pressure, cholesterol, and blood sugar level


  • Cholesterol-lowering drugs (e.g., statins)
  • Blood pressure medications
  • Antiplatelet or anticoagulant medications to prevent blood clots
  • Medications to alleviate leg pain during physical activity (e.g., cilostazol)

Medical procedures or surgeries:

  • Angioplasty, where a small balloon is inflated inside the narrowed artery to widen it
  • Stenting, where a small mesh tube is placed in the artery to hold it open after angioplasty
  • Bypass surgery, where a healthy blood vessel is taken from another part of the body and used to create a new path for blood flow around the blocked artery

Get a Fast, Painless Smart-ABI Test for PAD at University Foot and Ankle Institute

Remember, early detection is key to treating PAD effectively, so don’t ignore the signs of PAD. If you experience any of these symptoms, make sure to ask your doctor about our ankle-brachial index test.

This test will ensure that you get the treatment you need to avoid the risk of worsening cardiovascular disease, heart attack, amputations, and future vascular surgery.

To schedule a consultation with one of our renowned podiatristsplease call (855) 872-5249 ormake an appointment now.

We are conveniently located through the Los Angeles area with podiatry clinics in or near Santa Monica (on Wilshire Blvd.), Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia, California, to name a few. We are happy to offer a house x-rays, imaging, and physical therapy clinic.

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Dr. Gina Nalbandian, DPM

Dr. Gina Nalbandian is a fellowship trained foot and ankle specialist specializing in reconstructive and revisional foot and ankle surgery, foot and ankle trauma, sports medicine, and limb salvage.She is a member of American College of Foot and Ankle Surgeons (ACFAS) and American Podiatric Medical Association (APMA).

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How do I complete an ABI test? ›

During an ankle brachial index test, you lie on your back. A technician takes your blood pressure in both of your arms using an inflatable cuff, similar to the one used in the doctor's office. The technician also measures the blood pressure in the ankles. The doctor uses these values to compute your ABI.

What is the ABI cutoff for PAD? ›


PAD is graded as mild to moderate if the ABI is between 0.4 and 0.9, and an ABI less than 0.40 is suggestive of severe PAD [19].

What is normal range for ABI test? ›

Normal cut-off values for ABI are between 0.9 and 1.4. An abnormal ankle-brachial index- below 0.9-is a powerful independent marker of cardiovascular risk.

Does Medicare pay for ABI test? ›

Assessment of the Ankle brachial indices (ABI) only is considered part of the physical examination and is not covered according to Title XVIII of the Social Security Act section 1862 (a) (7) which excludes routine physical examinations and services from Medicare coverage.

What are the symptoms of a blocked artery in your leg? ›

The narrowing of the arteries causes a decrease in blood flow. Symptoms include leg pain, numbness, cold legs or feet and muscle pain in the thighs, calves or feet. The arteries which supply blood to the leg originate from the aorta and iliac vessels.

How accurate is the ABI test? ›

The ABI test approaches 95 percent accuracy in detecting PAD. However, a normal ABI value does not absolutely rule out the possibility of PAD for a few individuals. Some patients with a normal or near-normal ABI results may have few symptoms suggesting PAD.

What is the treatment for blocked arteries in the legs? ›

Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to your legs. Fatty deposits can build up inside the arteries and block blood flow. A stent is a small, metal mesh tube that keeps the artery open. Angioplasty and stent placement are two ways to open blocked peripheral arteries.

How can I check my leg circulation at home? ›

The test: Gather a few pillows or cushions and use them to prop up both legs so they're at a 45-degree angle while you lie on your back. As you're resting, notice if your legs become paler or retain their original color throughout the span of a minute.

What is a bad ABI score? ›

What does a high ankle-brachial index mean? An ABI ratio higher than 1.4 could mean the blood vessels in your limbs are stiff because of advanced age or diabetes. Researchers have found that people with an ankle-brachial index higher than 1.4 had twice the risk of cardiovascular death.

Can you have PAD with normal ABI? ›

In patients with normal ABI who are clinically suspected to have lower-extremity PAD, further diagnostic tests, including post-exercise ABI, toe-brachial index, pulse volume recordings, and duplex ultrasound should be performed to establish the diagnosis since a normal ABI does not definitely rule out a diagnosis of ...

What is the ABI of a patient with moderate PAD? ›

The initial test of choice includes the simple ABI measurement. Patients with an ABI of 0.41 to 0.90 are considered to have mild to moderate PAD, and patients with an ABI ≤0.40 are considered to have severe PAD.

What is the best treatment for PAD? ›

An effective treatment for PAD symptoms is regular physical activity. Your doctor may recommend supervised exercise training, also known as supervised exercise therapy (SET). You may have to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs can ease symptoms.

Can an ABI test be wrong? ›

There are very few false positives, so it doesn't require additional confirmatory testing to establish the diagnosis of PAD. Sometimes false-normal ABI results occur in cases of diabetic vascular disease or chronic kidney disease, but this would be rare in an asymptomatic patient.

Can peripheral vascular disease be cured? ›

There's no cure for peripheral arterial disease (PAD), but lifestyle changes and medicine can help reduce the symptoms. These treatments can also help reduce your risk of developing other types of cardiovascular disease (CVD), such as: coronary heart disease.

Is an ABI test expensive? ›

We set the base-case cost of the ABI test in the outpatient setting at $100 and include a sensitivity analysis for this cost. The costs of accompanying physician visits are also included in the model set at a base case of $200.

What kind of doctor performs ABI test? ›

Podiatrists will first conduct a visual inspection for any wounds, discoloration, and any abnormal signs prior to a vascular test. The most common tests include: Ankle-Brachial Index (ABI) examination.

Why would a doctor order an ABI test? ›

Why it's done. The ankle-brachial index test is done to check for PAD — narrowed arteries that reduce blood flow, usually in the legs. An ankle-brachial index test might be useful for people who have leg pain while walking. The test also can be useful for people who have risk factors for PAD .

What is the best vitamin for peripheral artery disease? ›

Folate and other B vitamins.

One study shows that higher amounts of folate supplements might help in the prevention of PAD, but experts need to study this more to confirm the relationship.

What is considered the first symptom of peripheral arterial disease? ›

The classic symptom of PAD is pain in the legs with physical activity, such as walking, that gets better after rest. However, up to 4 in 10 people with PAD have no leg pain. Symptoms of pain, aches, or cramps with walking (claudication) can happen in the buttock, hip, thigh, or calf.

Can you unblock arteries that are in legs? ›

Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to your legs. Fatty deposits can build up inside the arteries and block blood flow. A stent is a small, metal mesh tube that keeps the artery open. Angioplasty and stent placement are two ways to open blocked peripheral arteries.

What does claudication feel like? ›

Claudication is a symptom of a narrowing or blockage of an artery. Typical symptoms of claudication include: Pain, a burning feeling, or a tired feeling in the legs and buttocks when you walk. Shiny, hairless, blotchy foot skin that may get sores.

Can you improve ABI? ›

If you have decreased blood flow through your arteries, your health care provider can suggest things you can do to improve your circulation, such as quitting smoking or increasing your exercise. You may need to have anon-surgical or surgical procedure to improve your circulation.

What causes falsely elevated ABI? ›

The ABI may be falsely elevated in patients with diabetes mellitus or end-stage renal disease due to calcified vessels. These patients should undergo further testing to determine arterial sufficiency.

How can I unblock my arteries in my legs naturally? ›

You can “unclog” your arteries with natural methods, including diet, exercise, and stress management. Quitting smoking, if you smoke, can also help reverse plaque.
Are there natural ways to unclog arteries?
  1. reducing high cholesterol.
  2. reducing high blood pressure.
  3. quitting smoking, if you smoke.
Sep 26, 2022

What can be mistaken for peripheral artery disease? ›

Because peripheral artery disease affects the lower extremities, they can sometimes be mistaken for peripheral neuropathy symptoms, and vice versa. However, in contrast there are a few outlying symptoms that set them apart; they include: Cramps in the thigh, calf, ankle, buttocks, or foot. Difficulty climbing stairs.

What type of doctor treats poor circulation in legs? ›

A vascular doctor is a doctor who specializes in the treatment of arteries and veins. They can help you with a variety of issues that affect your blood vessels. Your family doctor can recommend a vascular doctor to help you with your specific issue.

What are four signs of poor circulation? ›

Poor circulation can cause a number of symptoms, including:
  • Muscles that hurt or feel weak when you walk.
  • A “pins and needles” sensation on your skin.
  • Pale or blue skin color.
  • Cold fingers or toes.
  • Numbness.
  • Chest pain.
  • Swelling.
  • Veins that bulge.
Sep 27, 2021

What does poor circulation in ankles look like? ›

Swollen ankles and feet, discolored or blue and red toes, hair loss on the legs and thin, dry, or cracked skin can be symptoms that someone with poor circulation can experience.

What is abnormal toe pressure on ABI? ›

A toe systolic pressure greater than 30 mmHg may be an indicator that there is healing potential in a foot with ulcers. A normal TBI differs from a normal ABI because the normal blood pressure in the big toe (hallux) is expected to be less than at the ankle or the arm.

Does PAD occur in both legs? ›

Both legs are often affected at the same time, although the pain may be worse in 1 leg. Other symptoms of PAD can include: hair loss on your legs and feet. numbness or weakness in the legs.

What aggravates peripheral vascular disease? ›

Smoking and high cholesterol levels increase the risk for PAD progression in large blood vessels (such as the legs), while diabetes increases the risk for PAD in small blood vessels (such as the feet). Quitting smoking and controlling cholesterol and high blood pressure are the best ways to slow PAD progression.

What is vascular leg pain like? ›

Vascular pain often feels like an uncomfortable heaviness or throbbing sensation. It can also feel like an aching sensation. It usually affects your legs and can be worse with walking or exerting yourself.

Is aspirin good for peripheral artery disease? ›

A. People with peripheral artery disease (PAD) in the legs have blockages (plaques of atherosclerosis) in the arteries that impair the flow of blood. Based on large scientific studies involving over 5,000 people with PAD, authorities recommend taking a daily aspirin tablet.

What are the 6 blood pressures that are recorded for an ABI test? ›

Six values are typically recorded:
  • Right brachial systolic pressure.
  • Left brachial systolic pressure.
  • Right posterior tibial artery (PTA) systolic pressure.
  • Left posterior tibial artery (PTA) systolic pressure.
  • Right dorsalis pedis artery (DPA) systolic pressure.
  • Left dorsalis pedis artery (DPA) systolic pressure.
Feb 26, 2021

What ABI is safe for compression? ›

Wound Care Providers

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.

Is PAD a progressive disease? ›

Peripheral artery disease (PAD) is a progressive narrowing of the blood vessels most often caused by atherosclerosis, the collection of plaque or a fatty substance along the inner lining of the artery wall.

How long can PAD go untreated? ›

This risk means that one in five people with PAD, if left undiagnosed and untreated, will suffer a heart attack, stroke, or death within five years. Untreated PAD can have other serious consequences, including leg muscle pain, discomfort during exercise, and loss of mobility and independence.

Is the ABI test painful? ›

This may be a little uncomfortable, but it won't hurt. The technician will slowly release the pressure in the cuff. The systolic pressure is the pressure at which the blood flow is heard again. That is the part of the blood pressure measurement needed for the ABI.

What is the next step after abnormal ABI? ›

The flow of testing to perform when an ABI falls outside of the normal range follows this simple algorithm: If an ABI is greater than 1.4, obtain a TBI. If an ABI is between 0.9–1.4, you're either done or perform exercise ABIs. If an ABI is less than 0.9, perform duplex and / or exercise ABIs.

Can you test ABI with a stethoscope? ›

However, this device is not always available for primary care physicians. The ABI measured with stethoscope is an easy alternative approach, but have not been proved to be useful.

Can you live a full life with peripheral artery disease? ›

You can still have a full, active lifestyle with peripheral artery disease, or PAD. The condition happens when plaque builds up in your arteries. This makes it harder for your arms, legs, head, and organs to get enough blood. Although it's serious and can sometimes be painful, there are lots of ways to slow it down.

What is the average age for peripheral vascular disease? ›

Age: PAD usually strikes patients after age 50. Tobacco use: Smoking and chewing tobacco are the biggest contributors to PAD. High blood pressure and high cholesterol: These conditions increase your risk.

Can you reverse PAD with exercise? ›

Can peripheral artery disease be reversed? Yes. Some studies have shown that you can reverse peripheral vascular disease symptoms with exercise and control of cholesterol and blood pressure. With early diagnosis, lifestyle changes and treatment, you can stop PAD from getting worse.

How do I prepare for an ankle-brachial index test? ›

No special preparations are needed for an ankle-brachial index test. The test is painless and similar to having blood pressure taken in a routine medical visit. Wear loose, comfortable clothing. This allows the provider doing the ankle-brachial index test to easily place a blood pressure cuff on an ankle and upper arm.

Can you do an ABI without a Doppler? ›

In fact, ABI ratios can be even be calculated without the use of a Doppler pen. In an emergency situation when an ABI machine or a Doppler pen is not available, you can simply grab a portable blood pressure (BP) machine.

Which 2 arteries are being evaluated in an ABI exam? ›

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.

How accurate is ankle brachial test? ›

The ABI test approaches 95 percent accuracy in detecting PAD. However, a normal ABI value does not absolutely rule out the possibility of PAD for a few individuals. Some patients with a normal or near-normal ABI results may have few symptoms suggesting PAD.

Can you eat before an ABI test? ›

There is very little you need to do to prepare for an ABI test. You can eat a normal diet on the day of the test. You shouldn't need to stop taking any medicines before the test. You may want to wear loose, comfortable clothes.

What is alternative test for ABI? ›

The alternative ABI was calculated for each leg by dividing the lower of the posterior tibial or dorsalis pedis pressures by the higher of the left or right brachial systolic pressures. Then, the leg with the lower ABI measurement was recorded as the alternative ABI value.

Can a nurse perform an ABI? ›

ABI measurement is primarily performed by nurses (93%) for the purpose of wound management (90%).

Who can perform ABI test? ›

The ankle brachial index is a medical test used to help identify peripheral artery disease (PAD). PADnet® is a quick and easy way to perform an ABI test, and can typically be performed by a medical assistant, and be evaluated remotely by a vascular specialist.

What is peripheral artery disease caused by? ›

Peripheral arterial disease (PAD) in the legs or lower extremities is the narrowing or blockage of the vessels that carry blood from the heart to the legs. It is primarily caused by the buildup of fatty plaque in the arteries, which is called atherosclerosis.

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