IMPORTANCE OF COMBINED MULTI-SEGMENTAL PRESSURE AND DOPPLER FLOW VELOCITY STUDIES IN DIAGNOSIS OF PERIPHERAL ARTERIAL OCCLUSIVE DISEASE

  • 1 January 1978
    • journal article
    • research article
    • Vol. 84  (6) , 840-847
Abstract
The value of combined multisegmental pressures and quantitative Doppler flow velocity determinations in preoperative vascular laboratory evaluation was analyzed in 100 patients with angiographically documented peripheral arterial occlusive disease. Erroneously normal or even high segmental pressure readings appear to be caused by increased arterial wall stiffness and may produce falsely elevated or erroneously normal pressures, suggesting less disease than exists, especially when only ankle pressure screening is used. The addition of quantitative flow velocity determinations significantly improved the reliability of diagnostic decision making. The diagnosis of proximal arterial occlusive disease based on combined pressure-velocity measurements was confirmed angiographically in 143 of 148 limb studies (96.6%), including several with normal pressures and reduced velocity values, a pressure-velocity dissociation. A decrease of the leg segment:arm pressure ratio, combined with only a slight reduction of velocity indices, suggests a stenosis with good local collateral flow and vessel patency at the site of measurement, a reversed pressure-velocity dissociation. A decreased lower limb segment:arm pressure ratio, combined with a significant reduction of velocity indices, is evidence of arterial stenosis with poor local collateral flow. The combined multisegmental pressure and velocity evaluation of patients suspected of arterial occlusive disease substantially increases the reliability of noninvasive diagnosis and offers a new level of differential diagnostic interpretation.