Femoral pulse palpation before and after exercise: a guide to occult iliac stenosis?

Iliac artery stenosis may produce significant haemodynamic impairment in the absence of any visible iliac narrowing on uniplanar arteriography. Such stenoses may be unmasked by the use of biplanar angiography or by direct femoral pressure measurements before and after papaverine. The aim of this study is to determine whether simple femoral pulse palpation is a reliable guide to haemodynamic impairment in the radiologically normal aorto-iliac segment, and in particular whether occult iliac stenosis can be unmasked by noting a reduction in the palpable pulse after exercise. Twenty-nine limbs with normal aorto-iliac segments on uniplanar angiography were examined at rest and after exercise and the femoral pulses were graded clinically. Haemodynamic assessment was performed by direct femoral pressure measurements before and after intra-arterial papaverine injection. Significant haemodynamic impairment was noted in 8 out of 29 limbs. Six of these 8 limbs had normal resting femoral pulses and 4 of the 8 limbs had a diminished pulse after exercise. Four out of the 21 limbs with normal haemodynamic studies had diminished pulses after exercise. Resting femoral pulse palpation is a poor guide to radiologically occult but haemodynamically significant iliac stenosis although pulse palpation after exercise may help to unmask a proportion of such stenoses.