Segmental pressure examination

With a four-cuff technique, the high thigh pressure should be higher than the higher systolic brachial pressure. A <30 mmHg difference between the higher systolic pressure and high thigh pressure is considered abnormal.

A 20 mmHg or greater reduction between segments in the same leg or compared with the opposite leg at the same level (ie, right thigh/left thigh, right calf/left calf) is indicative of a flow-limiting lesion at that level.

In this patient, the right high thigh pressure is borderline abnormal, and pressure gradients are present from the high to low thigh, low thigh to calf, and calf to ankle, indicative of multilevel disease. The ankle-brachial index of 0.17 is consistent with chronic limb-threatening ischemia. The left extremity demonstrates mild tibial vessel disease with adequate collateralization. The left ankle-brachial index of 0.84 is consistent with symptoms of mild claudication.