The significance for morbidity and mortality of Doppler-absent pedal pulses

The 1-month prognosis of 91 limbs with a pulseless foot in 49 patients was determined and related to elements of the physical examination, including Doppler ultrasonography. The risk factors that could predict loss of limb and death in this group of patients were determined. Gangrene and atrophy coupled with absent ultrasound signals predicted a 75% risk of loss of limb; this occurred despite attempted surgical intervention. Absence of Doppler signals in both ankle arteries was the strongest risk factor for predicting death. This is probably because ultrasound signals are absent only when arterial disease is far advanced. We conclude that Doppler ultrasound examination of the pulseless foot yields useful prognostic information relative to the fate of the limb and the patient who possesses such a limb.