Evaluation of cuff-wrapping methods for the determination of ankle blood pressure

OBJECTIVE: The ankle-brachial index, which is calculated by dividing ankle systolic blood pressure by brachial systolic blood pressure, is useful in diagnosing peripheral arterial disease. Consensus has not been reached, however, on a standard method for measuring ankle systolic blood pressure. This study evaluated two cuff-wrapping methods for measuring ankle systolic blood pressure, compared with intra-arterial pressure as a gold standard. METHODS: Study participants were 24 consecutive adult patients who underwent surgery under general anesthesia at Kyoto Prefectural University Hospital in Japan between January and March 2002. Indirect ankle systolic blood pressure was measured in the posterior tibial artery using a Doppler device and two cuff-wrapping methods: spiral, and straight. Direct ankle systolic blood pressure was measured in the dorsalis pedis artery. RESULTS: Mean difference in ankle systolic blood pressure between indirect and direct measurements (indirect minus direct) was 1.4 mmHg [standard deviation of the difference (SDd), 17.6 mmHg] with the straight method and -1.4 mmHg (SDd, 22.2 mmHg) with the spiral method. The limit of agreements (mean difference ±2 SDd) and intraclass correlation coefficient between two observers were -17.6 to 20.1 mmHg and 0.94, respectively, for the straight method and -39.4 to 40.0 mmHg and 0.78, respectively, for the spiral method. CONCLUSIONS: The straight method, the same cuff-wrapping method used for measuring brachial blood pressure, appears to represent a more suitable wrapping method because of better interobserver reproducibility. Accuracy and reproducibility of indirect ankle systolic blood pressure measurement, however, were not adequately improved by either of the wrapping methods.