Patient Selection

Ankle-Brachial Index (ABI)

Peripheral Arterial Disease (PAD) Diagnosis:
ABI is widely used to diagnose PAD, especially in patients with risk factors like diabetes, smoking, or hypertension. It helps in identifying arterial blockages that reduce blood flow to the lower limbs.
Cardiovascular Risk Stratification:
ABI serves as an indicator of systemic atherosclerosis and is linked to increased risks of heart attacks and strokes. Low ABI values can identify patients at higher cardiovascular risk.
Monitoring PAD Progression:
Physicians use ABI for follow-up assessments in PAD patients to monitor the progression of the disease or the effectiveness of treatments, such as medication or revascularization procedures.
Pre-surgical Evaluation:
ABI testing is used preoperatively to assess the vascular status of patients undergoing lower extremity surgeries or interventions, ensuring that sufficient blood flow is present.

Toe-Brachial Index (TBI) Applications:

PAD Diagnosis in Diabetics and Elderly:
In cases where arterial calcification in the lower limbs (common in diabetic and elderly patients) may result in falsely elevated ABI readings, TBI is preferred for more accurate detection of PAD. The smaller arteries in the toes are less likely to be calcified.
Assessment of Small Vessel Disease:
TBI is useful for evaluating small vessel disease in patients with conditions like diabetes, where the ABI might not reflect the true extent of vascular compromise.
Wound Healing Prognosis:
TBI can help in predicting the likelihood of wound healing in the lower extremities, especially in patients with foot ulcers or after amputations.
Follow-up for PAD Patients with Calcified Arteries:
For patients whose arteries are non-compressible due to calcification, TBI offers a reliable alternative for assessing blood flow in the lower extremities.

Patient Selection

It is reported that 2 out of 3 patients with Peripheral Artery Disease are asymptomatic

The PARTNERS study found that 29% of high-risk patients were diagnosed with PAD

For every symptomatic patient there are 2 asymptomatic patients. In order to capture every patient with PAD it is medically necessary to test over 10 high-risk patients for each symptomatic patient.

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There has been a paradigm shift in the patient selection criteria for peripheral artery disease (PAD). Published literature suggests clear justification that it is medically necessary to test all patients at high risk for PAD. This includes patients with 2 or more comorbidities. Utilize the Smart-ABI 15 point (CPT code documentation) patient questionnaire at intake.

Patient Intake Questionnaire

The American Heart Association and American Diabetes Association recommend testing high-risk patients.