title: How accurate are high thigh narrow cuff pressure measurements in the assessment of aorto-iliac obstructive disease?
abstract: Thigh cuff pressure measurements are commonly used as a diagnostic method in the assessment of the aorto-iliac (AI) segment of patients with arterial obstructive disease. For a reliable assessment of the AI segment the use of a narrow cuff placed high on the thigh has been advocated. Although this method is commonly used, opinions on its diagnostic value are very divergent. To investigate its diagnostic value the pressure measured with a high thigh narrow cuff was compared with the intra-arterial pressure of the common femoral artery measured at rest and during reactive hyperaemia. Furthermore, the accuracy of these thigh pressures for detecting haemodynamically significant (HDS) AI stenoses was examined. The influence of an occlusion of the superficial femoral artery (SFA) on the pressure measurements was also studied. A correlation coefficient of 0.64 (P less than 0.05) was found between the femoro-brachial index (FBI) at rest and the thigh-brachial index (TBI). Using the TBI as a criterion for detecting a HDS AI stenosis, an accuracy of 73% could be obtained. Furthermore, it appeared that an occluded SFA could influence the pressure measurements dramatically. For clinical practice a TBI less than 0.90, in the presence of a patent SFA, ensures the presence of an HDS AI stenosis. A TBI greater than 1.35 suggests that the AI tract is normal, irrespective of the condition of the SFA. All other values of TBI should be interpreted with caution and only used as a decisive diagnostic method for the assessment of the haemodynamics of the AI segment in combination with other tests.
authors.affiliation: Clinical Vascular Laboratory, St. Radboud University Hospital, Nijmegen, The Netherlands.
authors.forename: W J
authors.initials: WJ
authors.lastname: Beijneveld
authors.forename: W N
authors.initials: WN
authors.lastname: van Asten
authors.forename: W E
authors.initials: WE
authors.lastname: Rutten
authors.forename: P F
authors.initials: PF
authors.lastname: Wijn
authors.forename: S H
authors.initials: SH
authors.lastname: Skotnicki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000175:diagnosis* / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000601:surgery; D001795:Blood Pressure Determination / Q000295:instrumentation*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007511:Ischemia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D013848:Thigh / Q000098:blood supply*