The application of isotope limb blood flow measurement to diagnostic problems in vascular surgery.

A new method of limb blood flow measurement has been developed; normal flow is 10-22 ml/100 ml of tissue/min and flow to limbs with claudication is 1.8-2.3. Does this technique help to deal with diagnostic problems in vascular surgery? Twenty-five patients presented with exercise-induced leg pain. Twelve had a convincing history of claudication but seven of these had palpable pedal pulses, the other five had normal Doppler ratios. Of 13 with a poor history six had absent pulses; of the other seven with palpable pulses, two had abnormal and five had normal Doppler ratios. All 25 patients have had blood flow to both legs measured. For the five with a poor history, palpable pulses and normal Doppler ratios: (Table: see text). Twelve had reduced flows consistent with claudication (less than 8 ml/100 ml of tissue/min); 10 of these have undergone arteriography which demonstrated significant vascular disease, one had surgery to rheumatoid toes deferred and one refused further investigation. Of 13 with normal flows nine have been found to have significant orthopaedic problems affecting spine, hips or knees, the other four have all had normal arteriograms. In every case the history, signs or Doppler ratios were potentially misleading, but all cases of significant arterial disease were detected. It is cheap, readily available and effectively selected cases for referral or arteriography.