Ankle-brachial index · Sibiu

The ankle-brachial index in Sibiu, five minutes that show how blood flows in your legs

A simple comparison between the blood pressure at your ankle and the one at your arm shows whether the arteries of the legs have narrowed. The same figure says something about the heart as well.

Book an appointment 0771 193 295

What the ankle-brachial index is

The ankle-brachial index is a simple measurement that compares the blood pressure at your ankle with the one at your arm. Blood pressure is measured in both arms and at both ankles, then the ankle value is divided by the higher arm value. The result is a number, and that number says how well blood flows through the arteries of the legs.

The logic behind it is easy to follow. In someone with clear arteries, the pressure at the ankle is at least equal to the pressure at the arm. If an artery in the leg has narrowed because of atherosclerotic plaque, the pressure beyond the narrowing drops and the ratio falls below 1.

The investigation is also known as the ABI, from ankle-brachial index. It is non invasive, involves no needles, no contrast agents and no radiation, and it is done with a blood pressure cuff and a pocket Doppler probe that listens to the flow in the artery at the ankle.

What the measurement is really looking for is peripheral arterial disease, that is atherosclerosis in the lower limbs. The important detail is that a low value does not speak about the legs alone. A patient with peripheral arterial disease statistically carries a higher risk for the heart and the brain as well, because atherosclerosis is a disease of the whole arterial system, not of one segment.

That is why the measurement plays a double role at a cardiology clinic. It is a test for the legs and, at the same time, an indicator of overall cardiovascular risk, obtained in a few minutes and with no discomfort.

When it is worth measuring

Most patients arrive at this investigation from two directions: either they have a symptom when walking, or they have risk factors that justify a check even though they feel nothing.

Your calf, thigh or buttock hurts when you walk and the pain eases when you stop
You feel weakness or cramps in your legs on exertion, always after the same distance
You have diabetes, especially for more than ten years
You smoke or smoked for many years
You have high blood pressure or raised cholesterol
You are over 65, or over 50 if you have diabetes or smoke
You have a wound on your foot or toe that is not healing at the usual pace
The skin on your calves is thin and shiny, with less hair, or your feet are cold
Plaque has been found in your carotid arteries, or you have already had a cardiovascular event
You have chronic kidney disease or a family history of early arterial disease

If you have pain in your leg at rest, especially at night, or a wound that is turning black, do not wait for an ordinary appointment. Those are signs that call for prompt assessment.

How the measurement goes

It takes about fifteen minutes, is done lying on the examination couch, and does not hurt.

Resting first
You lie on your back for five to ten minutes so your blood pressure settles. If you have climbed stairs or arrived in a hurry, that wait matters, because otherwise the readings come out falsely high.
Measuring at the arms
The cuff goes on each arm and the systolic pressure is measured, with the Doppler probe over the artery at the wrist. Both arms are used, because a large difference between them is itself meaningful.
Measuring at the ankles
The cuff moves down to the calf, just above the ankle, and the probe listens in turn to the posterior tibial artery and the dorsalis pedis artery, on each foot. You hear a sound like a wave, which is your own blood flow.
The calculation
For each leg the higher ankle value is taken and divided by the higher arm value. That gives two indices, one for the right leg and one for the left, and the lower of the two carries the verdict.
The conversation
I explain what the number means in your case, alongside the rest of the picture: blood pressure, cholesterol, blood sugar, smoking, symptoms. You leave with the interpretation in writing and with the next steps, if any are needed.

How the result is read

Between 1.00 and 1.40 the value is considered normal. The arteries of the legs carry blood without a significant narrowing.

Between 0.91 and 0.99 the result is borderline. It does not mean established disease, but it does mean the measurement is worth repeating and following, especially if you have symptoms or risk factors.

At 0.90 or below we are talking about peripheral arterial disease. From there on, what matters is how low the value is and what symptoms you have, and the next step is usually an arterial Doppler ultrasound, which shows exactly where the narrowing sits.

Above 1.40 the number can no longer be read as such. A value that high appears when the arteries are stiff and no longer compress under the cuff, which happens often in patients with long standing diabetes or kidney disease. In that case other methods are used, for example the toe-brachial index.

These thresholds are the ones in the 2024 European guidelines on peripheral arterial and aortic diseases and in the American Heart Association statement on measuring the index. They are not the clinic's thresholds, they are international ones.

What follows an abnormal result

A low index is not a sentence, and it does not send anyone straight to surgery. In most cases the first step is treating what caused the narrowing: stopping smoking, controlling cholesterol with a statin, controlling blood pressure and blood sugar, often an antiplatelet drug.

The second step, just as important, is walking. A supervised walking programme is one of the few interventions that concretely improve the distance you can cover without pain, and the effect shows in weeks, not years.

Further investigations, an arterial Doppler ultrasound for instance, are recommended when symptoms limit everyday life or when the value is markedly low. The decision to intervene belongs to vascular surgery, and the role of the consultation here is to establish whether and when a referral makes sense.

In parallel, a low index also changes the way we look at the heart. The patient's cardiovascular risk is recalculated upwards and prevention becomes firmer, even if the heart has given no sign yet.

Prices

Prices
Service	Price
Cardiology consultation + ECG	400 lei
Cardiology consultation + ECG + echocardiography	620 lei
Cardiology follow-up + ECG	300 lei
Echocardiographyincludes an orientative assessment of the liver, the carotid arteries and the thyroid	400 lei
Holter ECG monitoring24 hours	370 lei
Ambulatory blood pressure monitoring (ABPM)24 hours	370 lei
Exercise stress test on a cycle ergometer	450 lei
Body composition analysis	100 lei
Ankle-brachial index (ABI)with interpretation	100 lei
Electrocardiogram (ECG)	100 lei
ECG + SDS (sudden death screening)extended BTL assessment, for people up to the age of 35	150 lei
Intravenous Ferinject 500 mgmedication and medical supervision included	800 lei
Intravenous vitamin C (Pascorbin 7.5 g)product and medical supervision included	350 lei

You have seen the prices. Shall we go ahead?

Tell us what brings you to a cardiologist and we will suggest a time that works for you.

Book an appointment 0771 193 295

Frequently asked questions

Does measuring the ankle-brachial index hurt?

No. A blood pressure cuff is inflated on your arm and on your calf, exactly as in an ordinary blood pressure reading. There are no needles, no injected substances and no radiation.

How long does it take?

About fifteen minutes, of which five to ten are the rest beforehand. The measurements themselves take a few minutes.

How do I prepare?

Come in loose clothes that roll up easily above the ankle, and avoid hard exercise and coffee in the hour beforehand. There is no need to fast, and do not stop your medication without discussing it first.

What are the normal values?

Between 1.00 and 1.40. Between 0.91 and 0.99 the value is borderline and gets reassessed, and at 0.90 or below peripheral arterial disease is diagnosed. Above 1.40 the arteries are too stiff for the index to be interpretable.

What does a value below 0.9 mean?

It means blood reaches the leg with more difficulty, because of a narrowing along the arterial path. That is the diagnosis of peripheral arterial disease and, at the same time, a signal that overall cardiovascular risk is higher than it seemed.

Does a normal result completely rule out disease in the leg arteries?

Not completely. In some patients with clear symptoms, the index measured at rest can come out normal, and the narrowing only shows on exertion. If your story suggests the disease but the number is normal, we discuss measuring after exercise or an arterial Doppler ultrasound.

Why is it measured in both legs and both arms?

Because the disease is often asymmetrical, and one leg can be affected while the other is clear. Measuring both arms also catches pressure differences between them, which carry their own meaning.

How often should it be repeated?

It depends on the result and on your risk factors. With a borderline value, or in a patient with diabetes who smokes, repeating it yearly is reasonable. With a normal value and low risk it is repeated far more rarely, usually when new symptoms appear.

I have had diabetes for years. Does that matter?

Yes, in two ways. Diabetes raises the risk of peripheral arterial disease and, over time, can stiffen the arteries, which pushes the index artificially above 1.40. In those patients the interpretation is done carefully and, where needed, with alternative methods.

Can it be done in the same visit as the consultation?

Yes, it can be done within the cardiology consultation, without a separate appointment. Tell us when you book that you are interested, so we can set aside the time.

Do I need a referral?

No. The clinic works on direct payment, and appointments are made by phone or through the form on the site.

What do I take home after the investigation?

The measured values, the index for each leg, the interpretation in writing and the recommendations that follow from it, from treatment to the date of your next check-up.