British Lymphology Society. Position paper for ankle brachial pressure index (ABPI). 2018. (accessed 23 October 2022)

Critical Appraisal Skills Programme. CASP checklists. 2021. (accessed 23 October 2022)

Crawford F, Welch K, Andras A, Chappell FM. Ankle brachial index for the diagnosis of lower limb peripheral arterial disease. Cochrane Database Syst Rev. 2016; 2016:(9)

Da Costa DL, Corlett SA, Dodds LJ. A narrative review on the consultation tools available for pharmacists in the United Kingdom: do they facilitate person-centred care?. Int J Pharm Pract. 2020; 28:(4)301-311

Ding T, Lloyd H. Perceptions of primary care and hospital clinicians on the use of the ankle brachial pressure index in general practice. J Prim Health Care. 2021; 13:(2)165-170

Fortune Business Insights. Compression therapy market size, share and industry analysis, by product (compression garments {compression bandages, compression stockings, and others}, compression pumps, and others), by application (venous leg ulcer, deep vein thrombosis (DVT), lymphedema, and others), by end user (hospitals & clinics, nursing care centers, home care, and others), and regional forecast, 2019–2026. Report ID FBI102689. 2020. (accessed 23 October 2022)

Guest J, Ayoub N, Mcllwraith T Health economic burden that different wound types impose on the UK's National Health Service. Int Wound J. 2017; 14:(2)322-330

Guest JF, Fuller GW, Vowden P. Venous leg ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J. 2018; 15:(1)29-37

Heatley F, Saghdaoui LB, Salim S, Onida S, Davies AH. Primary care survey of venous leg ulceration management and referral pre-EVRA trial. Br J Community Nurs. 2020; 25:S6-S10

Long HA, French DP, Brooks JM. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Res Methods Med Health Sci. 2020; 1:(1)31-42

Manchester University NHS Foundation Trust. Introduction of a new leg ulcer pathway and Urgostart dressings for venous leg ulcers in Manchester. Shared learning relating to NICE medical technologies guidance MTG42. 2020. (accessed 23 October 2022)

National Institute for Health and Care Excellence. How should I interpret ankle brachial pressure index (ABPI) results? Clinical Knowledge Summary. 2021. (accessed 23 October 2022)

National Institute for Health and Care Excellence. Peripheral arterial disease: How should I assess a person with suspected peripheral arterial disease? Clinical Knowledge Summary. 2022. (accessed 23 October 2022)

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Systematic Reviews. 2021; 10

Payne D. Leg care: improving assessment and adherence. Nursing and Residential Care. 2019; 21:(7)370-376

Phillips CJ, Humphreys I, Thayer D Cost of managing patients with venous leg ulcers. Int Wound J. 2020; 17:(4)1074-1082

Scott J, Lecouturier J, Rousseau N Nurses' and patients' experiences and preferences of the ankle-brachial pressure index and multi-site photoplethysmography for the diagnosis of peripheral arterial disease: a qualitative study. PLoS One. 2019; 14:(11)

Song P, Rudan D, Zhu Y Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. Lancet Glob Health. 2019; 7:(8)e1020-e1030

Todd M. Assessing and managing patients with leg ulceration and oedema. Br J Nurs. 2019; 28:(20)1282-1287

Trevethan R. Subjecting the ankle-brachial index to timely scrutiny: is it time to say goodbye to the ABI?. Scand J Clin Lab Invest. 2018; 78:(1–2)94-101

Weller C, Richards C, Turnour L, Green S, Team V. Vascular assessment in venous leg ulcer diagnostics and management in Australian primary care: clinician experiences. J Tissue Viability. 2020; 29:(3)184-189

Evaluation of an automated anklebrachial pressure index calculator in a nurse-led leg ulcer clinic. 2016. (accessed 23 October 2022)

Yap Kannan R, Dattani N, Sayers RD, Bown MJ. Survey of ankle–brachial pressure index use and its perceived barriers by general practitioners in the UK. Postgrad Med J. 2016; 92:(1088)322-327

Use of ankle–brachial pressure index to assess patient suitability for lower limb compression

10 November 2022
Volume 31 · Issue 20



Compression therapy is a safe, effective treatment for lower leg conditions such as lymphatic insufficiency and venous hypertension. The most common method of arterial assessment is the calculation of a patient's ankle–brachial pressure index (ABPI). The need for ABPI is highlighted in many best practice statement and local policies. ABPI compares the arterial flow of the arms and the legs, providing a ratio used to determine the presence and severity of peripheral artery disease and assess whether a patient is suitable for compression therapy.


This study critically reviews and analyses findings from contemporary literature with the aim of evaluating the effectiveness of the ABPI screening tool.


A structured literature review using a narrative approach was carried out.


Four studies were identified for inclusion, which involved medical, nursing and allied health professional staff in primary and secondary care, with a total of 51 patients. Analysis generated eight themes: appropriateness of the ABPI tool; clinician education; referral process; access to appropriate equipment; lack of time to conduct the assessment; competence; associated costs; and role definition.


It is important to undertake a holistic assessment of the patient, incorporating ABPI assessment where not contraindicated. Further research to explore patient experience and safety when assessing a patient's suitability for lower limb compression therapy is required.

Compression therapy is proven to be a safe and effective treatment for lower leg conditions such as lymphatic insufficiency and venous hypertension. In 2018, approximatively 250 million people across the globe were treated with compression therapy (Fortune Business Insights, 2020).

The most common method of arterial assessment is the calculation of a patient's ankle-brachial pressure index (ABPI) and the measurement and recording of this is embedded within many policies and best practice statements. ABPI compares the arterial flow of the brachial artery in the arm and the dorsalis pedis artery and/or posterior tibial artery in the leg, providing a ratio determining the presence and severity of peripheral artery disease (PAD), therefore assessing an individual's suitability for compression therapy alongside an in-depth holistic leg assessment (Song et al, 2019).

Lower limb disorders and leg ulcers are some of the most common conditions treated in the UK by the NHS (Heatley et al, 2020). It is estimated that 1.5% of the adult population are living with an active leg ulcer and around 80% of these lesions are classed as a venous leg ulcers (VLUs). Managing these patients is thought to cost the NHS around £2 billion each year (Todd, 2019; Heatley et al, 2020; Manchester University NHS Foundation Trust 2020).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content