If you have been told you might benefit from compression stockings, you may be surprised to learn that a simple test called an ankle-brachial index, or ABI, often comes first. Many patients in Forest Hills and throughout Queens ask us why they cannot simply buy stockings off the shelf and start wearing them. The answer comes down to safety: compression therapy is helpful for many vein conditions, but it can be harmful if you have poor arterial circulation in your legs.
At M&S Vascular and Orthopedic Group P.C., Dr. Amir Salem, our specialist in interventional radiology and vascular surgery, frequently performs ABI testing before recommending compression stockings. In this article, we explain what the test involves, why it matters, and what you can expect at your visit.
Why an ABI Test Is Recommended Before Compression Stockings
Compression stockings work by applying graduated pressure to your legs, squeezing hardest at the ankle and gradually loosening as the stocking moves up the leg. This pressure helps push blood back toward your heart and reduces swelling, discomfort, and the risk of blood clots.
However, that same pressure becomes a problem if the arteries in your legs are already narrowed or blocked by peripheral artery disease, often called PAD. When arteries cannot deliver enough blood to your lower legs, external compression can restrict blood flow even further. In moderate to severe cases, this can lead to skin breakdown, ulcers, or worsening pain.
An ABI test measures the blood pressure at your ankles and compares it to the blood pressure in your arms. The resulting ratio tells your vascular specialist whether your arterial circulation is strong enough to tolerate compression safely. It is a quick, painless screening that takes the guesswork out of treatment.
What Is an Ankle-Brachian Index Test?
Despite the technical name, the ABI test is one of the simplest studies we perform in the office. There are no needles, no dyes, and no radiation involved.
Here is how it works. You lie down and rest for a few minutes so your blood pressure settles into a baseline. A blood pressure cuff is placed on your arm and inflated, just like during a routine checkup. A small handheld device called a Doppler probe is used to listen to the pulse in your artery. The cuff is then deflated, and the pressure at which the pulse returns is recorded.
The same process is repeated at each ankle, typically on two arteries per leg. Your ankle pressure is then divided by your arm pressure to produce a ratio, which is your ABI score.
Understanding Your ABI Results
A normal ABI score generally falls between 1.0 and 1.4. This means the blood pressure at your ankles is equal to or slightly higher than the pressure in your arms, which is expected in healthy circulation.
Scores between 0.9 and 1.0 are usually considered borderline and may prompt closer monitoring. A score below 0.9 suggests some degree of peripheral artery disease. The lower the number, the more significant the arterial narrowing is likely to be. Scores below 0.7 generally indicate that compression stockings should be avoided or used only under careful supervision.
In some patients, particularly those with diabetes or long-standing vascular disease, the arteries in the legs become stiff and do not compress normally. This can produce an artificially high ABI score, sometimes above 1.4. When that happens, Dr. Salem may recommend additional testing, such as a toe-brachial index or a duplex ultrasound, to get an accurate picture of your circulation.
What Happens If My ABI Is Normal?
If your results show healthy arterial flow, you are generally a good candidate for compression therapy. Your provider will then focus on selecting the right compression level for your condition.
Compression stockings come in different strengths, measured in millimeters of mercury, or mmHg. Common options include:
- Mild compression (8 to 15 mmHg): Often used for everyday fatigue, minor swelling, or long periods of sitting or standing.
- Moderate compression (15 to 20 mmHg): Frequently recommended for varicose veins, travel, pregnancy-related swelling, and mild venous insufficiency.
- Firm compression (20 to 30 mmHg and above): Typically prescribed after procedures, for more advanced venous disease, or for managing conditions like deep vein thrombosis under medical guidance.
Your vein specialist will also discuss proper fit, since stockings that are too loose provide little benefit and stockings that are too tight can cause problems of their own. Accurate measurements of your ankle, calf, and sometimes thigh are taken to ensure the right size.
What Happens If My ABI Shows Poor Circulation?
If your test suggests peripheral artery disease, compression stockings may not be appropriate right away. The good news is that identifying arterial disease early is valuable in itself, because it allows you and your care team to address the underlying problem.
Depending on your results, Dr. Salem may recommend further evaluation of your arteries, lifestyle changes such as walking programs and smoking cessation, or medications to improve circulation and manage risk factors like high blood pressure and cholesterol. In some cases, minimally invasive procedures can open narrowed arteries and restore blood flow. Once your arterial health is better managed, compression therapy may be revisited.
It is worth noting that many patients have both venous and arterial problems at the same time. This is exactly why testing before prescribing stockings is so important: the two conditions can look similar on the surface, with leg pain, swelling, and skin changes, but they require very different approaches.
Common Conditions That May Require Compression Therapy
Patients come to our Forest Hills office for ABI testing and compression evaluations for a wide range of reasons, including:
- Varicose and spider veins: Enlarged, visible veins that may ache, throb, or feel heavy.
- Chronic venous insufficiency: Faulty vein valves that allow blood to pool in the legs, causing swelling and discomfort.
- Leg swelling from prolonged standing or sitting: Common among people with desk jobs, healthcare workers, teachers, and frequent travelers.
- Post-procedure recovery: Compression is often part of the plan after vein treatments to support healing.
- Lymphedema: Swelling caused by fluid buildup in the lymphatic system.
If you are experiencing leg heaviness, aching, visible veins, swelling, or skin changes around your ankles, an evaluation can identify the cause and determine whether compression is right for you.
Why Choose M&S Vascular and Orthopedic Group?
Choosing the right provider matters, especially when a condition like PAD could be hiding behind symptoms that seem purely venous. At our practice in Forest Hills, Queens, patients benefit from a truly comprehensive approach. Dr. Amir Salem brings expertise in both interventional radiology and vascular surgery, allowing him to evaluate your circulation thoroughly and offer minimally invasive treatment options when needed.
For patients whose leg pain stems from musculoskeletal issues rather than vein problems, Dr. Mehran Manouel, our orthopedic surgery and sports medicine specialist, provides expert evaluation and care. Having both specialties under one roof means fewer referrals, faster answers, and coordinated treatment.
We also pride ourselves on clear communication. You will leave your visit understanding your results, your diagnosis, and your options, without feeling rushed or confused.
Frequently Asked Questions
How long does an ABI test take?
Most ABI tests take about 15 to 30 minutes from start to finish, including rest time before measurements begin.
Is the ABI test painful?
No. The test uses blood pressure cuffs and a Doppler probe on the skin. You may feel brief pressure from the cuff inflation, but there is no pain afterward.
Do I need to prepare for the test?
Avoid smoking or vigorous exercise for a couple of hours beforehand, since both can affect your results. Wear comfortable clothing that can be rolled up above the knee, and remove stockings or socks before your appointment.
Will my insurance cover compression stockings?
Coverage varies. Medically graded stockings prescribed for certain diagnoses may be covered, while over-the-counter pairs usually are not. Our staff can help you understand your benefits.
Can I buy compression stockings without a test?
You can purchase low-level stockings over the counter, but if you have any risk factors for artery disease, such as diabetes, smoking history, or leg pain when walking, testing first is strongly advised.
Schedule Your ABI Test in Forest Hills, Queens
If you have been recommended compression stockings, or if you are experiencing leg swelling, aching, or visible veins, a quick ABI test can give you the answers you need to move forward safely. Dr. Amir Salem and the team at M&S Vascular and Orthopedic Group P.C. are here to help patients across Forest Hills and Queens protect their circulation and find lasting relief.
Call us today at (718) 897-2228 or visit https://www.msorthovasc.com to schedule your consultation. Your legs will thank you.