12
Parks Medical Electronics, Inc.
Aloha, Oregon U.S.A.
Diagnostic Procedures
Lower Extremity Segmental Systolic Pressures
Doppler segmental pressures can locate the general area of an occlusion or stenosis, and indicate the
severity of the disease. Radically different pressures between sites can isolate the region of an obstruc-
tion. Signi
fi
cantly different pressures at the same site on opposite legs can signal an obstruction proximal
to the site in the leg with the lower pressure.
Segmental pressures require the use of blood pressure cuffs sized for the area of the limb to be tested.
This test should be performed on a supine patient after at least 20 minutes rest. Bilateral systolic
pressures are obtained at these sites:
Arm, using highest
1.
brachial (or radial) artery reading, if ankle/brachial indices are indicated.
Ankle, using the
2.
doralis pedis or posterior tibial artery, whichever gives the higher reading.
Below knee (BK) or calf, using the doralis pedis or
3.
posterior tibial artery, whichever gives the higher
reading.
Above knee (AK), using popliteal artery if readings are dif
fi
cult to obtain with dorsalis pedis or
4.
posterior tibial artery.
High thigh (HT), using
5.
popliteal artery if readings are dif
fi
cult to obtain with dorsalis pedis or
posterior tibial artery.
Lower Extremity Segmental Pressures After Exercise
Doppler segmental pressures are measured after standardized exercise reproduces a patient’s ischemic
symptoms. The post-exercise (stress) drop in pressures can be diagnostic. Immediately after exercise,
the systolic pressure is taken in both ankles and then in the arm that had the greatest brachial systolic
pressure. If one leg is more symptomatic, the pressure should
fi
rst be measured in that ankle before
measuring the contralateral ankle. The length of time required to recover resting pressures is also noted.
Lower Extremity Segmental Pressures After Reactive Hyperemia
If exercise is not an option for the patient, reactive hyperemia can be induced. Thigh cuffs are in
fl
ated
20-30 mm Hg above the highest brachial pressure for 3-5 minutes and then released. Systolic pressures
are measured as with the exercise regimen. This procedure may be contraindicated because of the level
of discomfort associated with it.
Popliteal Artery
Summary of Contents for 915-BL
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