Despite initiatives to reduce risk factors through improved health screening, the rate of lower extremity amputation among veterans has risen in recent years. (iStock)
One out of every 100 veterans — an estimated 96,000 — has had a toe, foot or lower leg amputated, largely because of complications of diabetes, bacterial infections or peripheral artery disease, which reduces blood flow to the lower extremities.
Despite programs such as PAVE (Prevention of Amputation in Veterans Everywhere) that aim to reduce risk factors through improved health screening, the rate of lower extremity amputation among veterans has risen in recent years.
Ankle-brachial index (ABI) screening, which compares blood pressure in the arms and ankles, can detect peripheral artery disease (PAD). Since ankle pressure normally is slightly higher than arm pressure, a significantly lower ankle pressure and ABI value are indicative of PAD.
“Borderline” ABI readings traditionally have been interpreted as “nearly normal.” But that may not be the case, according to a new study by researchers at Vanderbilt Health.
In a review of the electronic health records of more than 223,000 veterans treated at Veterans Health Administration facilities, the researchers found that even modest decreases in the normal ABI correlated with a higher risk of major adverse limb events (MALE) requiring intervention, including amputation and revascularization (treatment to restore blood flow).
While further study is needed to understand why MALE occurs despite a near-normal ABI value, these findings suggest that a borderline ABI is not benign, and that “this terminology falsely reassures patients and clinicians,” the researchers concluded.
Recognizing how the continuum of ABI values may capture “the earliest signals of limb threat … offers an opportunity for earlier prevention and a new respect for a measure hiding in plain sight,” they added.
Aaron Aday, MD, MSc, Assistant Professor of Medicine and co-director of Vascular Medicine at Vanderbilt Health, is the first and corresponding author of the paper, which was published May 27 in the Journal of the American College of Cardiology.
Co-authors from Vanderbilt Health are Svetlana Eden, PhD, Suman Kundu, DSc, Robert Greevy, PhD, Amy Anderson-Mellies, MPH, Alexander Sullivan, MD, MSCI, Hilary Tindle, MD, MPH, and Matthew Freiberg, MD.
The study was supported in part by National Institutes of Health grants K23 HL151871, P01 AA029545 and U24 AA02079.
