A 65-year-old diabetic woman presents with a non-healing ulcer on the right lateral malleolus for 3 months. The ankle-brachial pressure index (ABPI) is 0.55 on the affected side. What does this ABPI value indicate and what is the most appropriate initial management?
- A Venous hypertension; start four-layer compression bandaging
- B Significant arterial insufficiency; refer for vascular assessment and consider revascularisation ✓
- C Mild arterial insufficiency; apply reduced compression bandaging
- D Normal perfusion; investigate for vasculitis
Correct answer: B. Significant arterial insufficiency; refer for vascular assessment and consider revascularisation
Explanation
An ABPI of 0.55 indicates severe peripheral arterial disease (PAD; normal >0.9; mild PAD 0.71–0.90; moderate 0.5–0.70; severe <0.5). An ABPI of 0.55 falls in the moderate-severe category and in a diabetic patient (where calcified vessels may falsely elevate ABPI) the true ischaemia may be worse. Compression bandaging is contraindicated when ABPI <0.8 as it risks critical limb ischaemia. The appropriate management is urgent vascular surgical referral for duplex ultrasound and consideration of revascularisation (angioplasty, bypass, or both) before addressing the wound.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.