Popliteal artery puncture in the assessment of patients with severe leg ischemia

Two-plane angiography and direct segmental pressure measurements in the femoral and popliteal arteries and indirectly on the arm and ankle were performed in 101 limbs seeking to establish a relationship between angiographic assessment of the patency of the popliteal artery and the trifurcation vessels and the popliteal ankle pressure difference. When the tiberoperoneal trunk or the trifurcation vessels were occluded or more than 50% of the lumen was stenosed, the pressure difference exceeded 10 mmHg in 30/40 limbs (75%). When three, two, or only one of the tibial vessels were patent, the pressure difference exceeded 10 mmHg in 2/58 limbs (3%). One month following above knee femoropopliteal bypass (48 limbs), patients with a popliteal-ankle difference less than 10 mmHg obtained a significantly higher ankle pressure index (PI 0.86, range 0.56-1.20) (p less than 0.01) than those with a pressure difference exceeding 10 mmHg (PI 0.66, range 0.40-0.91). The clinical state 6 months following femoropopliteal bypass did not demonstrate that patients with a low popliteal-ankle difference fared better than patients with a higher pressure difference; however, the PI appeared significantly lower in the latter group compared to the former. The graft material was correlated to the popliteal-ankle pressure difference. It appeared that prosthetic grafts failed within 6 months when the difference exceeded 10 mmHg in 10/12 limbs (83%), but autologous vein grafts only failed in 2/10 limbs (20%). Finally, it was possible to predict the postoperative ankle pressure index significantly from data derived from the pressure measurements.