ABI Assessment Before Compression: What Queens & Forest Hills Patients Should Know
Compression stockings and wraps are among the most commonly recommended treatments for leg swelling, varicose veins, and venous insufficiency. They work by applying graduated pressure to your legs, helping blood flow back toward your heart. For many people, they provide meaningful relief.
But here is something that surprises a lot of patients: compression therapy is not safe for everyone. If you have undiagnosed peripheral artery disease, wearing compression stockings can actually reduce blood flow to your legs and worsen your condition. That is why a simple, non-invasive test called the ankle-brachial index (ABI) is so important before starting any compression regimen.
At M&S Vascular and Orthopedic Group P.C. in Forest Hills, Queens, Dr. Amir Salem routinely performs this assessment as part of a thorough vascular evaluation. It takes just a few minutes, requires no needles, and can prevent serious complications down the road.
What Is an Ankle-Brachial Index Test?
The ankle-brachial index is a straightforward measurement that compares the blood pressure in your ankle to the blood pressure in your arm. The idea is simple: in a healthy circulatory system, the pressure at your ankle should be roughly equal to or slightly higher than the pressure at your arm.
If the pressure at your ankle is significantly lower, it suggests that arteries in your legs may be narrowed or blocked. This condition is called peripheral artery disease (PAD), and it affects millions of Americans, many of whom do not know they have it.
The test itself is painless. A technician or physician places a standard blood pressure cuff on your arm and another on your ankle. A handheld Doppler ultrasound device is then used to detect blood flow in the arteries. The entire process typically takes 10 to 15 minutes.
Why Compression Requires an ABI First
Compression stockings work by squeezing the legs from the outside. This external pressure helps push blood upward through the veins. In a person with healthy arteries, this is perfectly safe and effective.
However, if someone has arterial disease, their arteries are already struggling to deliver oxygen-rich blood to the legs. Adding external compression on top of already compromised arterial flow can reduce circulation further. In severe cases, this can lead to tissue damage, non-healing wounds, or even limb-threatening complications.
This is why responsible vascular specialists in Forest Hills and throughout Queens always check arterial status before prescribing compression. It is not an optional extra. It is a safety step that separates appropriate care from potentially harmful care.
Many patients come to us after being fitted for compression stockings at a pharmacy or by a provider who did not perform an ABI. We understand this is common, and we do not judge. But we do encourage anyone who has been prescribed compression without a prior arterial check to schedule an evaluation.
What Happens During the Test
When you visit Dr. Salem's office in Forest Hills, the ABI assessment is usually performed as part of a broader vascular consultation. Here is what you can expect.
First, you will lie down on an examination table and rest for a few minutes. This allows your blood pressure to stabilize. The technician will then place a blood pressure cuff on each arm and measure your brachial pressure (the pressure in the upper arm artery).
Next, cuffs are placed around each ankle. A Doppler probe is positioned over the posterior tibial artery and the dorsalis pedis artery at the ankle. These are the two main arteries that supply blood to the foot.
The highest ankle pressure is divided by the highest arm pressure to calculate your ABI. This is done for each leg. The result is a simple ratio, usually between 0.5 and 1.5.
There is no radiation, no injection, and no recovery time. You can drive yourself home and resume normal activities immediately.
Understanding Your ABI Results
The ABI number tells your doctor how well blood is flowing through the arteries in your legs. Here is a general guide to what the numbers mean.
1.0 to 1.4: This is considered normal. Blood flow through your leg arteries appears adequate, and compression therapy is generally safe from an arterial standpoint.
0.9 to 1.0: This is borderline. Your doctor may recommend monitoring and lifestyle modifications. Compression may still be appropriate, but your provider will weigh the risks and benefits carefully.
0.5 to 0.9: This suggests mild to moderate peripheral artery disease. Compression therapy is typically contraindicated or must be heavily modified. Further testing, such as an arterial ultrasound or CT angiography, may be needed.
Below 0.5: This indicates severe arterial disease. Compression stockings are contraindicated. You will likely need referral to a vascular specialist for advanced imaging and possible intervention.
It is worth noting that in some patients with diabetes or kidney disease, arteries can become calcified and stiff. This can produce falsely elevated ABI readings above 1.4. In those cases, additional tests like toe-brachial index or segmental pressures may be used.
What Happens If Your ABI Is Abnormal
An abnormal ABI does not mean you are out of options. It means your treatment plan needs to be adjusted to protect your arterial health.
If you have venous insufficiency and an abnormal ABI, Dr. Salem may recommend modified compression with lower pressure levels, or alternative treatments such as elevation, exercise programs, or venous ablation procedures that do not rely on external compression.
In some cases, treating the arterial disease first is the priority. This might involve medications, supervised exercise therapy, or minimally invasive procedures like angioplasty or stenting. Once arterial flow improves, compression may become safe again.
The key takeaway is that an abnormal ABI is not a dead end. It is information that helps your vascular doctor build a safer, more effective treatment plan tailored to your specific anatomy.
Who Should Get an ABI Before Starting Compression
Not every patient needs an ABI before wearing compression stockings. Young, healthy individuals with no risk factors for arterial disease are at very low risk. However, certain groups should always have this check.
You should request an ABI before starting compression if you are over age 50, have a history of smoking, have diabetes, have high blood pressure, have high cholesterol, have a family history of vascular disease, or experience symptoms like leg pain when walking (claudication), cold feet, or slow-healing wounds on your lower legs.
If you live in Queens and have any of these risk factors, it is worth asking your provider whether an ABI has been performed. If it has not, a visit to a vascular specialist in Forest Hills can provide clarity in a single appointment.
How to Choose the Right Provider
Not every clinic that sells compression stockings performs an ABI. Some pharmacies and retail stores fit compression products without any medical evaluation at all. While this is convenient, it skips an important safety step.
When choosing a provider for vascular care in Queens, look for a practice that offers diagnostic ultrasound, has a vascular specialist or interventional radiologist on staff, and routinely performs ABI testing as part of its evaluation protocol.
Dr. Amir Salem specializes in interventional radiology and vascular surgery, and his practice in Forest Hills includes the diagnostic tools needed to assess both venous and arterial health before recommending any treatment. This integrated approach means patients receive a complete picture of their circulation, not just a partial one.
Frequently Asked Questions
Does the ABI test hurt?
No. It feels similar to having your blood pressure taken. The Doppler probe makes a whooshing sound as blood flows, which some patients find interesting rather than uncomfortable.
How often should I get an ABI?
If you have diagnosed PAD or risk factors, your doctor may recommend checking it every one to three years. If your initial result is normal and you have no risk factors, routine retesting may not be necessary.
Can I wear compression stockings while waiting for my ABI?
If you have already been prescribed compression and are waiting for your test, ask your provider whether you should pause. If you have no symptoms of arterial disease, brief use is likely safe, but it is best to confirm with your doctor.
Is the ABI covered by insurance?
In most cases, yes. The ABI is a standard diagnostic test and is typically covered by Medicare and most private insurance plans when ordered for a medical reason.
Take the Next Step
If you are considering compression therapy for leg swelling, varicose veins, or venous insufficiency, make sure your arterial health has been checked first. A simple ABI test can protect you from potential harm and ensure your treatment plan is both safe and effective.
Dr. Amir Salem and the team at M&S Vascular and Orthopedic Group P.C. are here to help patients across Forest Hills, Queens, and the surrounding neighborhoods with thorough vascular evaluations and personalized treatment plans.
Call (718) 897-2228 or visit https://www.msorthovasc.com to schedule your consultation. Your legs deserve a plan built on complete information, not guesswork.