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October 1984

Noninvasive Techniques in the Assessment of Lower-Extremity Arterial Occlusive Disease: The Advantages of Proximal and Distal Thigh Cuffs

Author Affiliations

From the Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia.

Arch Surg. 1984;119(10):1145-1148. doi:10.1001/archsurg.1984.01390220031007

• We studied 209 limbs angiographically and noninvasively to determine whether measurements of upper-thigh (UT) and lower-thigh (LT) segmental pressures (four-cuff technique), combined with segmental pulse-volume recordings (PVRs), offered any advantage over the standard single-thigh cuff (three-cuff technique) and PVR in the diagnosis of aortoiliac (Al) and superficial femoral artery (SFA) occlusive disease. Angiographic stenosis of 50% or greater and occlusions were considered to be hemodynamically significant lesions in this study. In the absence of SFA disease, sensitivity to Al disease was high (96%) and not significantly different using three- or four-cuff measurements. However, in the presence of SFA-segment disease, four-cuff measurements, both with and without PVR, were significantly more sensitive to Al disease (100%) and more specific for a normal Al segment (76%) than the three-cuff, PVR technique. Plethysmography alone was most sensitive to SFA disease (90%), even in the presence of Al disease, and sensitivity was not improved by additional segmental pressure measurements. The four-cuff system enhances the physician's ability to diagnose Al disease in the presence of SFA lesions, while PVR is most useful in detecting SFA lesions in the presence of Al disease.

(Arch Surg 1984;119:1145-1148)

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