Segmental volume plethysmography in the diagnosis of lower extremity arterial occlusive disease

Over a 24 month period, segmental limb systolic pressures (SLP), pulse volume recordings (PVR) and bi-planar arteriograms were obtained for 202 lower extremities. The SLPs proved unsatisfactory for the localization of arterial disease and are presently employed only to assess the extent of limb ischemia. Bases on simple, qualitative criteria, the thigh PVR was graded as "normal" or "abnormal" and correctly predicted the presence or absence of hemodynamically significant aortoiliac disease in 95% of limbs. It there was a greater than 25% increase in the amplitude of the calf PVR relative to he thigh, patency of the superficial femoral artery was correctly identified in 97% of lower extremities. The limited accuracy of SLP alone in differentiating iliac and femoral artery occlusive disease, especially when present in combination, emphasizes the necessity of including some type of waveform analysis in the routine evaluation of patients with lower extremity arterial insufficiency.