Postural changes in femoral artery blood flow in normal subjects, patients with peripheral vascular occlusive disease and patients undergoing lumbar sympathectomy, measured by duplex ultrasound flowmetry.

Regulatory peripheral vasoconstriction occurs in response to lower limb dependency. In mildly ischaemic limbs these responses are retained but are lost in patients with rest pain. Previously used methods have inherent difficulties when applied during postural change. We studied orthostatic responses in 12 normal subjects (aged 22-74 years, median 52 years) and 16 patients (aged 21-83 years, median 48 years) with mild and severe peripheral vascular disease using a duplex ultrasound flowmeter. In the normal subjects the 60-s mean common femoral artery volume flow values (ml min-1 +/- S.D.) were 77 +/- 83; -78 +/- 116; -190 +/- 136 for elevation, dependency and standing respectively. For claudicants (n = 7) the values were 18 +/- 37; -112 +/- 123; -216 +/- 103, respectively. In rest pain patients (n = 9) the responses were reversed, being -252 +/- 124; 131 +/- 89 and 184 +/- 85. Significant differences were apparent between elevation, dependency and standing flows, in each of the three groups (all p less than 0.0001). The rest pain group displayed characteristically different responses compared with both normal subjects and claudicants, for each postural change (p less than 0.0001 in all cases). Investigation of the dependency response was undertaken in eight further patients with rest pain before and after lumbar chemical sympathectomy and a characteristic pre-sympathectomy response predicted the clinical outcome.