The pulse-reappearance time: an index of over-all blood flow impairment in the ischemic extremity.

A simple test is described to evaluate limb blood supply. The technique utilizes the delayed reappearance of the volume pulse after transient arterial occlusion. As monitored from the toe by a mercury-in rubber gauge, pulse reappearance (PRT) was instantaneous (less than one second) and the 50 percent of control amplitude reappearance time (PRT/2) was 3.4 +/- 0.8 seconds in 22 control subjects. A significant delay of the PRT and especially of PRT/2 was found in 60 patients with angiographically documented ischemic disease of the lower extremities. The delay was correlated closely with the severity of the disease: the mean PRT/2 for single level arterial disease (aortoiliac, femoropopliteal, posterior tibial, or anterior tibial artery obstruction) was approximately 25 seconds, and the mean PRT/2 associated with multilevel occlusion was 71 seconds. Since the technique is very simple, it may be used as a quick screening and follow-up procedure to detect the presence and over-all severity of peripheral arterial occlusive disease.