A systematic approach to the assessment of aortoiliac disease
B. L. Thiele, D. F. Bandyk, R. E. Zierler and D. E. Strandness Jr
The accurate localization of hemodynamically significant disease in the
aortoiliac segment remains a major clinical dilemma that contributes to the
less than optimal results reported for aortofemoral bypass grafting in
patients with disabling lower limb claudication. We assessed the
hemodynamic status of the aortoiliac segment with direct intraarterial
pressure measurements obtained prior to arteriography. This served as a
basis for determining the role of the femoral pulsatility index (FPI) in
evaluating the hemodynamics of the aortoiliac segment. A stepwise decision
making algorithm, developed from the results, enabled accurate
identification of the location of the hemodynamic disturbance in 94% of the
limbs studied. In 62% of the limbs, the FPI could be used, while in the
remaining 38%, intra-arterial pressure measurements were used.
