Hyperemic response for accurate diagnosis of arterial insufficiency.

Monitoring of calf (or ankle) blood pressure during reactive hyperemia after thigh arterial occlusion allows differentiation of normal from abnormal responses and of distal (femoropopliteal [FP] system) disease from proximal (aortoiliac [AI] disease. The hyperemic response of 106 lower extremities representing three disease states--FP (N = 19), AI (N = 15), and combined (AI plus FP)(N = 16)--were compared with each other and with 20 normal subjects and 36 asymptomatic diabetics. Not only were the three disease states readily distinguished from the very similar normal subjects and asymptomatic diabetics, but there was a highly significant difference between FP disease and AI disease up to 150 s. This is a simple, inexpensive, and reliable test that can be used at the bedside to determine levels of severe disease, especially in the claudicator, who may not have a critical stenosis under resting conditions.