Bilateral photoplethysmography studies of the leg arterial stenosis

A newly developed portable multi-channel photoplethysmography (PPG) device has been used for comparative studies of 20 healthy control subjects and 45 patients with diagnosed arterial stenosis in a leg. The peripheral blood pulsations were detected simultaneously at four body sites-the same fingers and toes of both arms and legs. The PPG pulses recorded at the periphery of the stenotic leg, if compared with those of the healthy leg, were much weaker, with delayed arrival as a consequence of increased pulse wave transit time (PWTT) due to higher vascular resistance. The specific PWTT delays for the occluded legs were in the range of 20-80 ms, while in the case of healthy subjects the leg PPG signals arrived without delays or with smaller time-shifts not exceeding 14 ms. The reference bilateral PPG signals detected at the fingertips did not show any notable PWTT delays in both groups. Parallel measurements of local blood pressures by means of the oscillometry method with subsequent calculation of the ankle-brachial index were performed. Convincing correlation between the bilateral differences in the local blood pressure (a routine tool for diagnostics of leg stenosis) and in the corresponding PWTT delay (Pearson's coefficient r = 0.93), as well as between the PWTT delay and the ankle-brachial index (r = -0.96) has been established. From the point of view of PWTT delay, the average value of leg stenosis diagnostic threshold was established to be in the range of 23 +/- 9 ms, with full reliability above 32 ms. The obtained data may find further applications in alternative methodologies for detection and/or assessment of arterial occlusions in human extremities.