Simultaneous determination of brachial and femoral arterial pressures during reactive hyperemia and papaverine vasodilation

Accurate assessment of aortoiliac occlusive disease often requires direct intraarterial pressure determination. Since these measurements may alter systemic pressure, brachial arterial pressure (BAP) and femoral arterial pressure (FAP) were obtained simultaneously to quantitate these changes. BAP and FAP were measured at rest, and then during vasodilation produced by postischemic reactive hyperemia and intra-arterial injection of papaverine. The gradient between FAP and BAP was used to assess the significance of an aortoiliac stenosis. Sixty-eight observations were performed in 19 limbs. During reactive hyperemia (n = 28), BAP was 142 ± 7 mm Hg, which was not significantly different from the baseline BAP of 142 ± 5 mm Hg. However, during thigh tourniquet inflation, BAP increased significantly to 158 ± 7 mm Hg. Following papaverine injection (N = 21) BAP was 144 ± 8 mm Hg, which was significantly different from both the baseline BAP (150 ± 6 mm Hg) and the preinjection BAP (156 ± 6 mm Hg). Postischemic reactive hyperemia and papaverine vasodilation produced comparable brachial to femoral pressure gradients. Use of baseline BAP is recommended for calculating gradients during reactive hyperemia, since the BAP is significantly elevated during tourniquet occlusion. Simultaneous recording of brachial and femoral pressures is recommended with intra-arterial papaverine injections, since the BAP varies significantly throughout the examination.