Toe pressure should be part of a vascular surgeon’s first-line investigation in the assessment of lower extremity artery disease and cardiovascular risk of a patient

Abstract Objective Toe pressure is an accurate indicator of the peripheral vascular status of a patient and thus cardiovascular risk, with less susceptibility to errors than ankle brachial index. This study aimed to analyse how ankle brachial index and toe pressure measurements associate to overall survival and cardiovascular death and to analyse the toe pressure of patients with ankle brachial index 0.9-1.3. Methods The first ankle brachial index and toe pressure measurements of consecutive 6784 patients treated at the Helsinki University Hospital vascular surgery clinic between 1990-2009 were analysed. Helsinki University vascular registry and the national Cause of death registry provided the data. Results The poorest survival was in patients with ankle brachial index >1.3, (10-year survival 15.3%; HR 2.2, 95%CI 1.9-2.6; p 50mmHg. Conclusions Low toe pressure associates significantly with survival and cardiovascular mortality. Patients with a normal ankle brachial index may have lower extremity artery disease and a considerable risk for a cardiovascular event. If only the ankle brachial index is measured in addition to clinical examination, a substantial proportion of patients may be left without lower extremity artery disease diagnosis or adequate treatment of cardiovascular risk factors. Thus, especially if ankle brachial index is normal, lower extremity artery disease is excluded only if also toe pressures are measured and are normal.