Prognostic value of consecutive peripheral pressure registration after reconstructive peripheral arterial surgery.

A reliable predictive test as a guide in selection for arterial reconstruction vs. primary amputation would be of great value. An ideal test should also be simple and noninvasive. We evaluated prediction based on preoperative and early postoperative (repeatedly in the first week) measurements of ankle and toe pressure in relation to patency 6 months after reconstructive peripheral vascular surgery in 39 patients. Occlusion occurred within 6 months in ten patients. In eight of them the preoperative ankle-brachial pressure index (ABI) was less than 0.4, but seven other patients with ABI less than 0.4 had maintained patency. In six of the ten with occlusion the toe-brachial pressure index (TBI) was less than 0.1, but in three others with TBI less than 0.1 the grafts were patent. During the first postoperative week there was progressive rise in pressure indices, reaching statistical significance on day 6, though with greatest rise on day 1. Although preoperative ABI less than 0.4 and TBI less than 0.1 were associated with high occlusion risk, the specificity of these indices was too low for predictive value. The repeated measurements during postoperative week 1 added no useful information to that obtained on day 1.