A test for evaluating pedal gangrenous lesions: observation of elevation reactive hyperemia as a gauge of blood supply.

Estimating the development of collateral circulation in peripheral vascular diseases is simplified by the use of an easy test-which can be done in an office-in which reactive hyperemia is observed in an extremity as it is gradually lowered after a period of elevation. The lower limits of filling pressures necessary to allow spontaneous healing of necrotic lesions under the conditions described seem to be in the range 35 cm. above the heart. Similarly the lower limit for the successful performance of amputations at the level of the forefoot or toes seems to be about 45 cm. As a result of over a thousand observations in a period of over five years, it is believed that the test provides in a few minutes a visual and reproducible picture of the filling pressures in the distal portions of the extremity which is useful in the determination of prognosis and the selection of treatment of gangrenous lesions of the foot.