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Femoral artery pulse rise time: an objective test for aorto-iliac disease
I L Green1, A D Taylor, R M Greenhalgh
1Department of Surgery, Charing Cross and Westminster Medical School, Charing Cross Hospital, London, U.K.
Insights
A new non-invasive method accurately assesses aorto-iliac arterial stenosis using common femoral pulse rise time. This technique offers superior diagnostic accuracy compared to clinical examination for identifying significant stenosis.
Area of Science:
- Vascular Surgery
- Medical Diagnostics
- Biomedical Engineering
Background:
- Aorto-iliac arterial stenosis significantly impacts patient health.
- Accurate, non-invasive diagnostic methods are crucial for effective treatment planning.
- Current methods may be invasive or lack sufficient diagnostic precision.
Purpose of the Study:
- To evaluate a novel non-invasive method for assessing aorto-iliac arterial stenosis.
- To determine the diagnostic accuracy of common femoral pulse rise time in identifying stenosis.
- To compare this method's efficacy against clinical examination and direct pressure measurements.
Main Methods:
- Utilized a hand-held variable capacitance pressure transducer to measure common femoral pulse rise time in 51 patients.
- Compared pulse rise time measurements with arteriographic assessments and direct intra-arterial pressure measurements.
- Analyzed data for sensitivity, specificity, and diagnostic accuracy in detecting >50% stenosis.
Main Results:
- A significant correlation was found between pulse rise time and arteriographic degree of stenosis (r = 0.80).
- Strong correlation observed between pulse rise time and common femoral/radial pressure ratios (r = -0.82).
- Achieved 97% sensitivity, 93% specificity, and 94% diagnostic accuracy for >50% stenosis, outperforming clinical examination (83% accuracy).
Conclusions:
- The described non-invasive method provides highly accurate objective assessment of aorto-iliac stenosis.
- This technique offers superior diagnostic accuracy compared to traditional clinical examination.
- The apparatus's simplicity and ease of use present advantages over complex non-invasive techniques.
Abstract:
A method is described for assessing stenosis in the aorto-iliac arterial segment using a hand-held variable capacitance pressure transducer to take objective measurements from the common femoral pulse. The aorto-iliac segments were studied in 51 arteriopaths and the common femoral pulse rise time derived. The patients also underwent an independent clinical examination. The rise time results from 88 common femoral pulses were compared with subsequent arteriographic assessment of the aorto-iliac segments, and in 67 cases with direct intra-arterial pressure measurements from the common femoral artery. A highly significant correlation coefficient was found between the common femoral pulse rise time and the degree of aorto-iliac stenosis on the arteriogram (r = 0.80). Similarly, there was good correlation between pulse rise time and the direct common femoral/radial pressure ratios (r = -0.82). The results were analysed in terms of sensitivity, specificity and diagnostic accuracy for determining greater or less than 50% stenosis on the arteriogram. Using a pulse rise time of 200 ms a sensitivity of 97%, specificity of 93% and diagnostic accuracy of 94% were obtained. This was significantly better than clinical examination which gave a diagnostic accuracy of 83% (X2 = 5.57, P less than 0.02). The results suggest that this non-invasive method of objective pulse assessment gives superior accuracy for diagnosing aorto-iliac stenotic disease. The ease of use and relative simplicity of the apparatus are advantages over more complex non-invasive techniques employing microprocessors in the analysis of blood velocity.