Femoral artery pressure measurement to predict the outcome of arterial surgery in patients with multilevel disease.

Direct measurement of the femoral artery pressure before operation has been used to predict the postoperative change in ankle and toe pressure in 102 limbs (83 patients) that underwent aortoiliac surgery for the treatment of atherosclerotic occlusion or stenosis affecting both the aortoiliac and femoral artery segments. Rest pain or gangrene was present in 74 limbs. In 26 other limbs simultaneous aortoiliac and femoral artery reconstructions were performed. The changes in both toe and ankle pressures could be confidently predicted from the preoperative data. A predicted toe pressure of lower than 25 mm Hg was associated with a high probability that amputation would be required. The chances of an amputation were less than 3% if a toe pressure higher than 40 mm Hg was predicted. If the predicted ankle pressure index was lower than 0.56, there was a 90% chance that intermittent claudication would persist. Measurement of the femoral artery pressure allows prediction of the toe and ankle pressure response to surgery to be made with sufficient accuracy to permit a preoperative decision to be made between the need for a single-level or a two-level arterial reconstruction: no patients who had an aortoiliac reconstruction needed a subsequent downstream repair of the femoral segment.