‘Pole Test’ Measurements in Critical Leg Ischaemia

AbstractBackgroundFor the quantification of critical limb ischaemia (CLI) most vascular surgery units use sphygmo-manometric and transcutaneous oxygen pressure (TcPO2) measurements. However, measurements obtained by cuff-manometry can be overestimated especially in diabetic patients because of medial calcification that makes leg arteries less compressible. TcPO2 measurements present a considerable overlap in the values obtained for patients with different degrees of ischaemia and its reproducibility has been questioned. Arterial wall stiffness has less influence on the pole test, based on hydrostatic pressure derived by leg elevation, and this test seems to provide a reliable index of CLI.ObjectiveThe objective of this study was to evaluate the pole pressure test for detection of critical lower limb ischaemia, correlating results with cuff-manometry and transcutaneous oxygen pressure.DesignUniversity hospital-prospective study.Materials and methodsSeventy-four patients (83 legs) with rest pain or gangrene were evaluated by four methods: pole test, cuff-manometry, TcPO2 and arteriography. CLI was present if the following criteria were met: (a) important arteriographic lesions+rest pain with an ankle systolic pressure (ASP) ≤40mmHg and/or a TcPO2 ≤30mmHg, or (b) important arteriographic lesions+tissue loss with an ASP ≤60mmHg and/or a TcPO2 ≤40mmHg. Fifty-seven lower limbs met the criteria for CLI.ResultsMeasurements obtained by cuff-manometry were significantly higher to those obtained by pole test (mean pressure difference: 40mmHg, p<0.001). The difference between the two methods remained statistically significant for both diabetics (50.73, p<0.001) and non-diabetics (31.46, p