Should ABPI be measured in patients with healed venous leg ulcers every three months?

Abstract

OBJECTIVE: To assess if three-monthly reassessment of ABPI is necessary and to determine the possibility of identifying which patients may benefit from more frequent reassessment. METHOD: The sample comprised 88 consecutive patients with 175 limbs attending community leg ulcer clinics for reassessment after leg ulcer healing had been achieved with compression therapy. Outcome measures were: a fall in ABPI to below 0.8, months between reassessments and arterial disease history. RESULTS: ABPI fell from above 0.8 to below 0.8 in seven limbs in six patients over time periods of between six and 24 months. Of these seven limbs, six had an ABPI between 0.8 and 1.0 at the initial assessment, indicating they had some arterial impairment. ABPI fell below 0.7 (0.58) in only one patient, and this was detected at a six-month reassessment. None of the patients with no or just one arterial symptom experienced a reduction in ABPI to below 0.8. Those whose ABPIs fell below this level had two or more arterial symptoms. CONCLUSION: Three-monthly reassessment of healed limbs is not recommended as most patients who initially have an ABPI above 1.0 are unlikely to change during this time. However, patients with two or more arterial risk factors, diabetes and an initial ABPI of below 1.0 are likely to need closer monitoring. More in-depth research is needed to examine this problem.