Open Access Research article

Applicability of the ankle-brachial-index measurement as screening device for high cardiovascular risk: an observational study

Bianca LW Bendermacher1*, Joep AW Teijink12, Edith M Willigendael2, Marie-Louise Bartelink3, Ron JG Peters4, Machteld Langenberg5, Harry R Büller6 and Martin H Prins2

Author Affiliations

1 Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands

2 Department of Epidemiology, Caphri Research School, Maastricht University, Maastricht, The Netherlands

3 University Medical Centre Utrecht, Julius Centre for Health Sciences and Primary Health Care, Utrecht, The Netherlands

4 Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

5 Gezondheidscentrum West, Den Bosch, The Netherlands

6 Department of Vascular Medicine and General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

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BMC Cardiovascular Disorders 2012, 12:59  doi:10.1186/1471-2261-12-59

Published: 30 July 2012



Screening with ankle-brachial index (ABI) measurement could be clinically relevant to avoid cardiovascular events in subjects with asymptomatic atherosclerosis. To assess the practical impact of guidelines regarding the use of ABI as a screening tool in general practice, the corresponding number needed to screen, including the required time investment, and the feasibility of ABI performance, was assessed.


An observational study was performed in the setting of 955 general practices in the Netherlands. Overall, 13,038 subjects of ≥55 years presenting with symptoms of intermittent claudication and/or presenting with ≥ one vascular risk factor were included. Several guidelines recommend the ABI as an additional measurement in selected populations for risk assessment for cardiovascular morbidity.


Screening of the overall population of ≥50 years results in ≈862 subjects per general practice who should be screened, resulting in a time-requirement of approximately 6 weeks of full time work. Using an existing clinical prediction model, 247 patients per general practice should be screened for PAD by ABI measurement.


Screening the entire population of ≥50 years will in our opinion not be feasible in general practice. A more rationale and efficient approach might be screening of subsets of the population of ≥55 years based on a clinical prediction model.