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Vascular Flow – ABI Testing

One of the many things we take for granted is blood flow. It’s not really a concern until things go bad.

As arteries travel away from the heart they branch into smaller and smaller vessels. If an artery narrows too much it can be like crimping a water hose. Blood flow will change from a strong stream to a trickle. Since arterial blood flow brings oxygen, a decrease in flow can have dramatic changes. This is especially true with your feet.

The Importance of Oxygen & Smart ABI Testing

We take in Oxygen when we breathe. The tough part is getting that oxygen to every part of the body. Muscles cramp, ulcers do not heal, and tissue dies when they are deprived of oxygen. 

Have you ever put a rubber band around your finger? Within 10 seconds, you’ll see a color change. After 1-2 minutes, a deep and overwhelming pain starts to set in – that’s ischemic pain. This is due to a lack of oxygen, which also results in cells starting to die. With this simple example, you can see why it is incredibly important to have appropriate blood flow to all parts of your body. 

This is where Smart ABI comes in. This is a non-invasive tool that utilizes inflatable arm and leg cuffs to test your blood flow. You’ll be in a reclined position, with no wires or tubes connected. No need for drawing blood, fasting, or other studies. The Smart ABI system will collect information via Bluetooth while the cuffs deflate. Your results and waveforms are available within minutes after that!

Do I Need Smart ABI Testing?

To start, we have three easy warning signs that you should come in.

Skin & Hair Concerns

Loss of hair growth is a good indicator of diminished vascular supply. Additionally, the skin will get thin and shiny. 

Capillary Fill Time

When you pinch the end of the toe, the color should normally take under 3 seconds to return to normal. If you’re still counting up to 5…6…7…8…9…10, you’re vascular flow is decreased. This is called capillary fill time and reflects the small vessel supply.

Muscle Cramping from Normal Activity or Light Exercise

Muscle cramping with activity is called claudication. Claudication is a red flag – like left arm pain before a heart attack. Look for foot, calf, or thigh pain with light to moderate activity. Walking for 10-30 minutes, 20-30 minutes of tennis activity, or shopping for 20-30 minutes can be the catalyst.  Symptoms will get better with rest but return when the same amount of activity is repeated.  This is not like the muscle cramping you get after long or intense exercise.

In this scenario, it is time to add an Endovascular specialist to the medical team. This type of doctor can open up vessels and restore flow from the groin to the top of the foot. They will try to avoid stents and vessel replacement.

Big Concerns That Need Immediate Attention

Resting leg pain – this is not normal and a real reason for concern. The level of oxygen is below the threshold for tissue survival. A skin ulcer or other foot concerns may not have the resources to heal. Dark or cyanotic tissue could be a sign of gangrene. It is essential you come in to see us right away.

This is the eleventh hour for limb salvage.  If a significant amount of tissue dies, we are going to lose parts. The pain from an ischemic limb is off the charts. The risk of sepsis dramatically increases.

a woman having a leg cramp because of poor circulation

So What Does That Mean

Not the worst scenario – The blood flow studies show decreased but reasonable flow or near normal flow with stiff vessels. The chance of complete healing is good but it will take longer. It is a really good idea to repeat this test annually to watch for changes.

The worst scenario – There is little to no chance of healing. We need to get better flow Pronto. Off to the endovascular Doc. They are my heroes!  They are able to open vessels to restore flow and the results are fast and furious. Most patients feel a difference before they reach the recovery room. Once the flow has improved, the ulcer will almost slam shut. I do little work at this point but get all the credit – doesn’t seem fair.

Wedding Bell Blues

There is a “Honeymoon period “for ulcers. They want to heal as fast as possible. But if there is a delay from limited blood supply it takes longer than 4 weeks to heal. After this period the wound may get lazy. It may now take 2-10 times longer to heal. On an open wound, regardless of size, is a neon sign advertising for bacteria. If enough bacteria enter the ulcer an infection will develop.  There is no happy ending when this happens.

Good Scenario– There is plenty of flow and Oxygen available. 

Who Should Get Tested?

If you have a history of:

  • Leg or foot ulcers
  • Coronary Artery Disease (CAD)
  • Peripheral Artery Disease (PAD)
  • A combination of Diabetes, Hypertension, and Elevated Cholesterol
  • Over 50 years old with Diabetes  
  • Over 50 years old and a nicotine user
  • Reoccurring muscle pain or cramping with walking (Claudication). 

Symptoms may be hidden if a person is not very active (walks less than 15-20 minutes).  Inactivity can provide a false sense of security that everything is fine.

Vascular testing is a good idea before any foot surgery with reduced vascular supply. This would include minor procedures like nail removal or a skin biopsy. We can avoid significant complications if we get an early warning.  

The Smart ABI results will be compared to a physical exam. Combining the risk factors and the Smart ABI results, annual testing may be recommended. Changes in vascular supply will often sneak up on you. Early detection and monitoring are key to continuing with a great health plan.

close up of a doctor checking his vascular flow

When You Don’t Need to be Tested

  • If you have good palpable pulses, you do not need to be tested.
    • There are 2 arteries that should be detectable in the foot. A trained physician can detect a pretty faint pulse. The ABI studies can give a better idea of how severe the faint pulse is. The test also lets us know if the vessels are not compressible. A stiff vessel will give a better reading than there should be.
  • If you can walk briskly for more than 30 minutes with no pain or concerns – no tests for you. 
  • If you have a dialysis stent in your arm – not a good idea.
  • If you have giant calves and arms since the cuffs may not fit you.

    Working Towards Healthy Circulation

    Our goal is to help you not only identify what may be causing your poor circulation but to help resolve issues so you continue to improve your health and reduce pain or discomfort. If you find yourself in any of the above warning signs, like a long capillary fill time or resting leg pain, give our office a call or use our online form to send us a message.


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    Indianapolis, IN 46216

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