<prompt> Artificially high readings of ABPI can be caused byArteriosclerosis calcified arteriesIschemic ulcersIntermittent claudicationDeep Vein Thrombosis  <response>: A Arteriosclerosis calcified arteries?Theory of ABPI:Ankle-brachial pressure index ABPIAnkle-Brachial index ABI:Ratio of blood pressure at ankle to blood pressure in upper arm brachium.Compared to arm, Lower blood pressure in leg suggests blocked arteries due to peripheral artery disease PAD.Ankle brachial pressure index ABPI is a method for the quantification of peripheral vascular disease that results from advanced atherosclerosis.The ABPI is the ratio of the systolic BP measured at the ankle to that measured at the brachial artery arm. RATING OF ABPIABI ValueInterpretationRecommendationGreater than 1.4CalcificationVessel HardeningVascular Intervention1.0-1.4Normal Resting ABPINone0.9-1.0Acceptable0.8-0.9Some degree of Arterial obstruction ClaudicationTreat risk factors0.5-0.8Moderate Arterial DiseaseVascular InterventionLess than 0.5Severe Arterial Disease Rest PainVascular InterventionLess than 0.3Imminent necrosisNeeds Vascular interventionIssues to look out for?Vessels are calcified, limbs are large, fatty, oedematous, cuff too small or limbs Dependant.Inappropriately high readings are obtainedInvestigations:ABPI:Normal value doesnt rule out ischemiaRetest after exercise, ABPI may fall.Post exercise ABPI considered POSITIVE when ABPI fall 0.2 andor Failure to return to baseline in 3 minutesWrong high readings in calcified arteries, e.g., seen in diabetics ESRD.Peripheral Vascular Disease: obstruction of large arteries not within the coronary, aortic arch or brain vasculatureMain cause is atherosclerosis.Risk Factors:Smoking, diabetes, HTN, sedentary lifestyle, increased cholesterol, obesity.Investigations: Bloods, ABPI, arterial duplex, MR angiographyManagement:Conservative measures - Lose weight, increased exercise, anti-hypertensives, statins, stop smoking.Surgery - Angioplasty, surgical bypass, amputation. 