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The Ankle-Brachial Index, commonly called ABI, is a simple and non-invasive examination that compares blood pressure at the ankles with blood pressure in the arms. It helps cardiologists assess circulation to the legs and identify possible peripheral arterial disease.
When combined with Pulse Wave Velocity, which evaluates arterial stiffness, the assessment can provide a broader understanding of vascular health, cardiovascular risk and vascular ageing.
At Cardiology Center Zacharias Kounnis in Limassol, ABI and Pulse Wave Velocity measurements are interpreted as part of a complete cardiovascular evaluation, not as isolated numbers.
During an ABI test, blood pressure is measured in the upper and lower extremities. The measurements are then used to calculate the relationship between the pressure reaching the ankles and the pressure measured in the arms.
The examination is:
Despite its simplicity, the ABI can provide important information that may change the direction of a patient’s investigation or treatment.
An abnormal ABI may indicate haemodynamically significant narrowing or obstruction in the arteries supplying the legs. This is known as lower-extremity peripheral arterial disease, or PAD.
PAD may cause symptoms including:
However, the importance of PAD extends beyond the legs.
Peripheral arterial disease is commonly associated with systemic atherosclerosis. This means that a patient with PAD may also have an increased likelihood of atherosclerotic disease affecting other parts of the cardiovascular system.
Identifying PAD can therefore influence the patient’s wider cardiovascular risk assessment and preventive treatment—not only the investigation of leg symptoms.
A normal resting ABI can provide valuable information, but it does not exclude every case of peripheral arterial disease.
When a patient has walking-induced leg symptoms and clinical suspicion remains high, a cardiologist may consider additional assessment. This may include a post-exercise ABI, vascular ultrasound or another appropriate investigation.
Post-exercise ABI testing examines how ankle pressure changes following physical activity. It can help reveal circulation problems that may not be apparent while the patient is resting.
The result should always be interpreted alongside:
A normal test result should redirect the investigation when appropriate, but it should not replace clinical judgement.
An ABI and Pulse Wave Velocity assessment examines two different aspects of vascular health.
ABI primarily evaluates whether there is evidence of significant obstruction in the peripheral arterial circulation.
Pulse Wave Velocity evaluates a different characteristic:
Healthy arteries expand and contract as blood is pumped from the heart. As arteries age, or are exposed to hypertension, diabetes, metabolic disease, smoking and other cardiovascular risk factors—they may gradually lose some of their elasticity.
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A pressure wave normally travels more quickly through stiffer arteries than through more elastic arteries. Pulse Wave Velocity measures this movement and provides clinically useful information about arterial stiffness.
PWV is not a search for a blocked artery. It evaluates the functional condition of the arterial system and can contribute to a broader understanding of cumulative vascular injury.
Vascular age is a clinical concept used to describe how the condition of a person’s arteries compares with what may generally be expected for their chronological age.
A person’s arteries may show signs of earlier vascular ageing due to factors such as:
Pulse Wave Velocity can contribute to an assessment of vascular ageing, but it should not be treated as a standalone diagnosis or an exact prediction of future cardiovascular events.
The result must be interpreted according to the measurement method, blood pressure, age and overall clinical context.
Cardiovascular prevention should involve more than telling patients that their blood pressure, cholesterol, glucose or weight should improve.
Whenever clinically appropriate, objective measurements can help evaluate whether a patient’s cardiovascular and vascular health is changing over time.
Repeat vascular measurements may complement clinical follow-up after:
The first measurement establishes a clinical baseline.
A later measurement may help determine whether the patient appears stable, improving or showing changes that require further investigation.
However, serial results must be compared carefully. Measurement conditions, blood pressure, equipment and clinical circumstances can influence the result. ABI and PWV should therefore be interpreted alongside symptoms, laboratory results, examination findings and other cardiovascular investigations.
No. Walking-induced leg pain may be caused by arterial disease, but it can also have neurological, spinal, muscular or joint-related causes.
For example, peripheral arterial disease and spinal conditions may both cause discomfort or weakness during walking. Some patients may also have abnormalities in both areas.
An abnormal spinal scan does not automatically prove that the spine is responsible for the symptoms. Similarly, a history of coronary disease does not automatically prove that walking-induced leg pain is caused by PAD.
Anatomical abnormalities and symptoms are not always the same thing.
The clinician must connect:
The goal is to continue the investigation until the symptoms and objective evidence form a medically coherent explanation.
Modern medicine offers highly advanced imaging and intervention techniques. However, sophisticated care does not always mean beginning with the most complicated examination.
A relatively simple physiological measurement can sometimes clarify whether a patient needs further vascular investigation or whether another cause of the symptoms should be considered.
ABI can help answer whether there is evidence of reduced arterial circulation to the legs.
PWV can add information about arterial stiffness and vascular ageing.
Neither measurement provides every answer, but both can contribute valuable evidence to the diagnostic and preventive process.
At Cardiology Center Zacharias Kounnis, ABI and arterial measurements are not viewed as isolated test results.
They form part of our wider approach to preventive cardiology and vascular medicine:
Heart • Arteries • Metabolism • Kidneys • Exercise • Lifetime Risk
Our objective is not simply to identify established cardiovascular disease.
We aim to understand:
This approach means listening carefully to the patient while remaining prepared to reconsider an initial diagnosis when objective evidence points in another direction.
An ABI test compares blood pressure in the ankles and arms. It is used to help detect reduced blood flow to the legs and assess for possible peripheral arterial disease.
ABI primarily evaluates lower-limb arterial circulation. Pulse Wave Velocity evaluates arterial stiffness by measuring how quickly the pressure wave travels through the arteries.
ABI is non-invasive and generally painless. Patients may feel temporary pressure when the blood pressure cuffs inflate.
It is possible. If symptoms suggest PAD despite a normal or borderline resting ABI, post-exercise ABI or other vascular investigations may be considered.
Yes, when clinically appropriate. Repeat measurements may support follow-up, but results should be obtained under comparable conditions and interpreted alongside the patient’s wider cardiovascular assessment.
If you experience walking-induced leg pain or have risk factors including hypertension, diabetes, high cholesterol, smoking, kidney disease or established cardiovascular disease, an ABI and Pulse Wave Velocity assessment may provide useful information about your vascular health.
Patients looking for a cardiologist in Cyprus can contact Cardiology Center Zacharias Kounnis in Limassol to discuss whether vascular assessment is appropriate for their symptoms and cardiovascular risk profile.
Good medicine is not about proving the first diagnosis correct. It is about continuing the investigation until the patient’s symptoms and the objective evidence agree.
Medically reviewed by Dr Zacharias Kounnis
Last reviewed: September 2026
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