A Novel Simple Technique Using Hyperemia to Enhance Pressure Gradient Measurement of the Lower Extremity during Peripheral Intervention

Purpose: To describe a novel technique coupling the use of a pressure-wire gradient measurement with and without hyperemia (induced with an external blood pressure cuff inflated to 20 mmHg above the systolic blood pressure for 1 minute on the affected calf). Case: A 70-year-old patient presented with lifestyle-limiting lower-extremity calf claudication. He underwent angiography, which revealed left superficial femoral artery stenosis. Angioplasty of the lesion improved the angiographic appearance, but a residual pressure gradient could be elicited with provocative hyperemia testing. This prompted stenting, which resolved the differential. Conclusions: Pressure-wire gradient detection with and without provocative hyperemia testing using our novel approach may prove to be a useful adjunct in the diagnosis and treatment of lower extremity occlusive disease.