• Monitoring of calf (or ankle) blood pressure during reactive hyperemia after thigh arterial occlusion allows differentiation of normal from abnormal responses and of distal (femoropopliteal [FP] system) disease from proximal (aortoiliac [AI]) disease. The hyperemic response of 106 lower extremities representing three disease states—FP (N = 19), AI (N = 15), and combined (AI plus FP) (N = 16)–were compared with each other and with 20 normal subjects and 36 asymptomatic diabetics. Not only were the three disease states readily distinguished from the very similar normal subjects and asymptomatic diabetics, but there was a highly significant difference between FP disease and AI disease up to 150 s. This is a simple, inexpensive, and reliable test that can be used at the bedside to determine levels of severe disease, especially in the claudicator, who may not have a critical stenosis under resting conditions. (Arch Surg115:851-856, 1980)

Hyperemic response for accurate diagnosis of arterial insufficiency.

• Forty-five limbs varying clinically from normal through moderate to severely ischemic were studied by noninvasive measurements of both arterial blood pressure and perfusion. From the values plotted on a two-coordinate system, they arranged themselves well into three clinical categories: (1) normal, (2) intermittent claudication, and (3) ischemia or ulceration and rest pain. Good clinical responses to arterial reconstruction were corroborated by postoperative measurements. Reinforcing the results of one measurement with those of the other has provided an objective, numerical, and graphic basis for decisions regarding the advisability of angiography or arterial reconstructive procedures or both. To date, almost 400 patients have been evaluated by these techniques. ( Arch Surg 112:679-683, 1977)

Noninvasive Assessment of the Peripheral Vascular System

Careful use of the data from the vascular laboratory has resulted in better patient and operation selectivity in peripheral arterial disease of the lower extremities Using the combination of segmental pressure measured with an ultrasonic Doppler and flow as approximated by the measurement of the rate of pulsatile volume change with a calibrated plethysmograph, objective criteria were established for arterial insufficiency Using a two cuff technique, resistance indices were established to distinguish femoropopliteal from aortoiliac disease The ratio of angiograms to femoropopliteal and aortoiliac operations has been reduced from an earlier value of almost 3/1 to the present value of approximately 1/1

Patient and operation selectivity. The peripheral vascular laboratory.

• A simple, inexpensive pulse wave recording device was tested in large (25- to 40-kg) dogs. Femoral arterial flow, prestenotic and poststenotic arterial waveforms, and pressures were monitored as stenosis was induced with a constricting silk loop. The recording device tested was placed around the distal leg. The pulse wave recorder accurately reproduced the arterial pulse waveform. The amplitude of the device's waveform was linearly proportional to the arterial pulse pressure. The instrument was sensitive in detecting a flow-limiting stenosis. The cuff represents an advance in noninvasive vascular assessment because it is quite inexpensive, portable, and durable, as well as precise and sensitive. ( Arch Surg 113:936-939, 1978)

A Simplified Instrument for Noninvasive Vascular Assessment: Results of Experimental Tests With Arterial Stenosis

A clinical trial was made of a new noninvasive technic for the measurement of arterial blood volume changes in a limb segment. The instrument employed is small, portable, provides a digital display in cc/min, is readily calibrated, gives reproducible values of the segmental phen be used to screen patients with peripheral vascular disease and to assess postoperative results.

Noninvasive measurement of pulsatile blood volume changes. Its usefulness in peripheral vascular disease.

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Noninvasive measurement of pulsatile blood volume changes. Its usefulness in peripheral vascular disease.