Validation of Doppler measurement of pressure gradients across peripheral model arterial stenosis

Hemodynamic assessment of aortoiliac occlusive disease is necessary for successful arterial reconstruction of the legs. Various methods have been proposed, and the "pull through" intraarterial pressure measurement method is accepted as the best standard. The pressure readings, however, seemed to depend on the intraluminal position of the catheter. To explain these observations and make a comparison between the Doppler method and the pull through method, we have studied centerline velocity changes at the stenosis throat by Doppler ultrasonography, and axial and lateral pressure gradients by use of pressure transducers mounted 10 mm and 40 mm downstream of short (4 mm) axisymmetric sharp-edged model stenoses having cross-sectional reduced areas of 64%, 84%, 91%, and 96%. Axial manometric pressures measured 10 mm beyond the throat of 84% stenosis were more than twice as high as the lateral pressures. No significant difference was observed between axial and lateral pressures measured 40 mm downstream from the throat. This pressure distribution has important clinical relevance. Mean and peak pressure gradients for both the Doppler method and manometric measurements were compared. Measurements with Doppler method and manometric measurements indicated that mean pressure gradients (r = 0.98; SEE = +/- 2.4 mm Hg) correlate better than peak pressure gradients (r = 0.90; SEE = +/- 16.5 mm Hg). Doppler gradients were higher than manometer gradients. Overestimation was 13% for mean pressure gradients and ranged from 10% to 150% for peak pressure gradients. Explanation for the difference between mean Doppler and catheter gradient may be the pressure recovery occurring in the relaminarized poststenotic regions.