Arterial Segmental Pressures

1. Segmental pressures

a. 4-cuff method uses 12 cm cuff (bladder width) at the high thigh, low thigh and calf levels.  For the arm and ankle, 10 or 12 cm cuff may be used based on the limb size (cuff width should be at least 20% greater than the diameter of the limb. Index comparing High Thigh pressure to highest of the two brachial pressures is normally 1.2 to 1.4.

b. 3-cuff method uses 18-20 cm cuff on the thigh in place of using two cuffs on the thigh. Index comparing the Thigh to the highest of the two brachial pressures is normally 1.0 to 1.2.

• Bilaterally abnormal High Thigh/Brachial Index indicates aortoiliac disease.

• Unilaterally abnormal Thigh/Brachial Index indicates iliac artery disease.

• Pressure gradients between adjacent cuffs are normally <20 mm Hg.  A gradient of 20-30 mm Hg is suspicious for disease.  Gradients that exceed 30 mm Hg between cuffs indicate hemodynamically significant stenosis.