Supine exercise testing in the selection of suprainguinal versus infrainguinal bypass in patients with multisegmental...

Proper assessment of aortoiliac disease requires hemodynamic evaluation during lower extremity vasodilatation. Two tests that meet this criterion, intraarterial papaverine injection and supine exercise of the lower extremities, were compared in 35 extremities of 27 patients. Hemodynamic improvement as measured postoperatively was used as the standard for comparison. Ergometer and papaverine tests were 100 percent and 94 percent accurate, respectively, had sensitivities of 100 percent and 100 percent, specificities of 100 percent and 93 percent, positive predictive values of 100 percent and 75 percent, and negative predictive values of 100 percent and 100 percent. The lower accuracy rate for the papaverine test was the result of two borderline (false-positive) examinations. The ergometer test is more accurate but less applicable than the papaverine test. Routine papaverine testing with adjunctive ergometer testing is a highly accurate method of assessing the hemodynamic significance of aortoiliac disease.