Pulse and blood pressure measurements taken in different areas of the body help diagnose peripheral arterial disease.
In the legs, doctors will commonly feel for pulses in the femoral
(groin), popliteal (back of the knee), posterior tibial (ankle), and dorsalis
pedis (foot) areas. Other pulses often checked include the radial (wrist), brachial
(forearm), and carotid (neck) areas.
The pulses are graded for record-keeping purposes so that doctors
can keep track of how a person's pulse changes over time. Your
doctor uses a number system to rate your pulse.
Your doctor will listen to your pulse with a stethoscope for a "whooshing" sound called a bruit (say "broo-E"). A bruit might mean there is a blockage in the artery.
For peripheral arterial disease, blood pressure might be taken at the ankles, toes, legs, and arms.
Blood pressures are typically taken with a blood pressure cuff. But blood pressure can be measured
using catheters placed inside the arteries. Because the
arteries are punctured, this is known as invasive blood pressure monitoring.
In most people, the resting ankle pressure is greater than the
pressure at the crook of the arm, known as the brachial blood pressure. The
ratio of the ankle pressure to the brachial pressure is called the
ankle-brachial index (ABI).
Toe pressures can be measured with miniature blood pressure cuffs to check for poor blood flow in the
Segmental leg pressures
Arterial pressure can be estimated in the upper thigh, above the
knee, and in the upper calf by placing blood pressure cuffs at the appropriate
levels. The pressures can be compared between the two legs or at different
levels in the same leg.
Blood pressures can be measured at the elbow (brachial), forearm, or
wrist. Large differences between pressures at the various levels suggest
arterial blockage. As with toes, finger pressures can be measured.
Other Works Consulted
Hirsch AT, et al. (2006). ACC/AHA 2005 practice
guidelines for the management of patients with peripheral arterial disease
(lower extremity, renal, mesenteric, and abdominal aortic): A collaborative
report from the American Association for Vascular Surgery/Society for Vascular
Surgery, Society for Cardiovascular Angiography and Interventions, Society for
Vascular Medicine and Biology, Society of Interventional Radiology, and the
ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop
Guidelines for the Management of Patients With Peripheral Arterial Disease):
Endorsed by the American Association of Cardiovascular and Pulmonary
Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular
Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease
Foundation. Circulation, 113(11): e463–e654.
October 14, 2011
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
& David A. Szalay, MD - Vascular Surgery
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