Physiologic and Noninvasive Studies to Document Severity and Extent of Aortoiliac Occlusive Disease



Physiologic and Noninvasive Studies to Document Severity and Extent of Aortoiliac Occlusive Disease



Nicholas H. Osborne and Peter K. Henke


The evaluation of patients who come to the hospital with symptoms of aortoiliac occlusive disease (AIOD) in the setting of peripheral artery disease (PAD) routinely includes methods for determining the anatomic location of and physiologic significance of the occlusive process. The primary decision involves assessing how disabling the symptoms are for the patient. However, for any given level of ankle measured perfusion (e.g., ankle-to-brachial index [ABI]), proximal AIOD is usually more disabling given the amount of muscle mass that is supplied distal to the occlusive processes.


Several noninvasive modalities can aid in the accurate diagnosis and physiologic assessment of the relevance of AIOD. These include ABI, segmental arterial pressures, and duplex ultrasonography.




Extremity Pressure Measurements and Doppler Analysis


Extremity pressure measurements are one of the most basic methods for diagnosing the level and severity of PAD. This starts with the basic ABI, which provides a very quick, reproducible, and noninvasive measurement and gives an estimate of the disease’s severity. In the absence of PAD, the ABI will be greater than 1.0. Although the definition of PAD is an ABI less than .90, some patients have an ABI greater than .90 but less than 1.0 as a result of excellent collaterals bypassing the AIOD. Measuring segmental systolic occlusive pressures using a blood pressure cuff applied at various levels of the leg with a Doppler probe provides a quick gauge of the level of disease. In those with AIOD, the segmental pressures are decreased at the proximal cuff thigh level (Figure 1). Most often, vascular labs combine the ABI with lower extremity arterial segmental pressure studies to better define if inflows, outflows, or combined disease exists.


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FIGURE 1 Example of bilateral lower extremity waveforms and segmental pressures. Note that the right leg shows no evidence of aortoiliac disease (thigh pressure is normal), but the left waveform and pressure at the high thigh are abnormal (84 mm Hg). BP, Blood pressure.

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Aug 25, 2016 | Posted by in CARDIOLOGY | Comments Off on Physiologic and Noninvasive Studies to Document Severity and Extent of Aortoiliac Occlusive Disease

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