*5.1.1 Ankle brachial pressure index*

Doppler measure Ankle brachial pressure index is most commonly used to screen the presence of Peripheral artery disease. However, Ankle brachial pressure index and other routinely performed non – invasive bedside tests otherwise useful in the assessment of Peripheral artery disease may be unreliable in patients with Diabetes [35]. Ankle brachial pressure index score of <0.9 is indicative of impaired blood flow; however the finding of a normal Ankle brachial pressure index in a person with diabetes is not reliable – increased arterial stiffness may reduce distal flow [36] and medial arterial calcification, resulting in incompressible vessels which may in turn causes falsely elevated pressures.
