Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Leg ulcer - venous - Management
How do I interpret Doppler studies?

  • A Doppler assessment of both legs and interpretation should be carried out on all people by an appropriately trained healthcare professional.
  • An ankle brachial pressure index (ABPI) involves the measurement of a person's systolic blood pressure at their ankle and arm (brachial) using a Doppler machine. The ABPI provides an index of vessel competency by measuring the ratio of systolic blood pressure at the ankle to that in the arm, with a value of 1 being normal. When interpreting ABPI in a person with venous ulcer, a ratio of:
    • Less than 0.5 indicates severe arterial insufficiency and compression treatment is contraindicated. Refer urgently to a specialist vascular clinic for further assessment.
    • Between 0.5 and 0.8 indicates that the person has arterial disease. Refer to a specialist vascular clinic for further assessment. Compression bandaging should generally be avoided. However, reduced compression can be used under strict supervision (assess progress daily) if the ulcer is clinically venous and the healthcare professional has sufficient experience.
    • Greater than 0.8 indicates that graduated compression bandages may be safely applied.
  • Be aware that the ABPI may decrease after the initial measurement. Arterial disease may develop in people with venous disease, and the ABPI will also reduce with increasing age.
  • People with diabetes mellitus, atherosclerotic disease, rheumatoid arthritis, and systemic vasculitis should be referred for specialist assessment as the ABPI in these people may not be reliable. These conditions may give falsely high (and misleading) ABPI readings due to calcification of the blood vessels.
Clarification / Additional information
  • A Doppler assessment measuring the ankle brachial pressure index (ABPI) should be carried out on all people with venous leg ulceration at:
    • The initial presentation.
    • Twelve weeks if there are signs of delayed or poor healing, and then at 3-monthly intervals until the ulcer has healed.
    • Six-monthly intervals when compression stockings are being used to prevent recurrent venous ulceration.
    • The first signs of ulcer deterioration, ulcer recurrence, sudden increase in ulcer size or pain, or change in foot colour or temperature.
Basis for recommendation
  • These recommendations are based on clinical guidelines The nursing management of patients with venous leg ulcers published by the Royal College of Nursing [RCN, 2006], and a guideline from the Scottish Intercollegiate Guidelines Network Management of chronic venous leg ulcers [SIGN, 2010], together with the best available trial evidence, informed expert opinion, and current good clinical practice.
  • An ankle brachial pressure index (ABPI) of < 0.9 is considered to be abnormal, and this cut-off has been shown in several clinical studies to be highly sensitive and specific for detecting peripheral arterial disease (positive predictive value of 95% and negative predictive value of 99%) [SIGN, 2010].
  • The Royal College of Nursing based their Doppler studies recommendations on a number of cohort and cross-sectional studies. Applying a compression bandage to a limb that has arterial insufficiency could lead to pressure damage, limb ischaemia, and even amputation [RCN, 2006].

© NHS Institute for Innovation and Improvement