Examination Plans

Assessment of toe pressures from patient in sitting position

For some patients measurement of toe pressures in sitting position is favorable rather than the recommended supine position. This can be the case for patients with critical limb ischemia were toe pressures in supine position are hard to assess or/and for patients that have difficulties to be place in supine position (pat. in wheelchair etc.). The assessment is done with the patient in sitting position on a chair, wheelchair or bedside and the result is automatically adjusted with regards to the hydrostatic pressure difference between the heart and the toe. The clinician types in the measured distance (cm) between the heart and the toe.

Valuable clinical information is added into the customized anamnesis section.

Example of report from assessment of sitting toe pressure. All values are adjusted with regards to the hydrostatic pressure difference between the heart and the toe.

Treadmill testing or exercise ABI

Perform an exercise provocation in all patients with claudication or pain in the legs while walking and who also have normal resting ankle-brachial index (ABI) values and toe pressures. Letting the patient walk until pain on a treadmill and then immediately putting the patient back in a supine position to perform a post-exercise ABI can quantify the blood pressure drop compared to resting. It is preferred to measure both limbs and the systolic arm pressure at the same time to give an as accurate ABI as possible, taking into account the potential for shifts in systolic pressure for these patients. This objective test makes it easy to confirm or rule out ischemia from the symptom of leg pain while walking.

Perimed provides a customized examination plan for treadmill testing were pressures are assessed before and after the exercise. Generated results are clearly displayed in numerical (absolute pressures and indexes) and in graphical form thereby facilitating the clinical decision. Degree of pain and a timestamp of its debut during the exercise is also added to the report.

Pressures and indexes in supine, resting position

Pressures and indexes after treadmill exercise

Finger pressure

Digit-Brachial Index (DBI) is the upper extremity equivalent of the lower extremity Ankle-Brachial Index. DBI < 0.75 are typically considered abnormal. Pressure assessment can be done on all digits or on selected digits with more pronounced problems. Measurement of digit pressure and digit brachial index are useful tools when assessing the existence of ischemia. Perimed provides customized examination plans for finger pressure assessment as well as for finger pressure assessment on patients fistula were measurement of brachial pressure in both arms is contraindicated.

Finger pressure- fistula

Finger pressures are taken from all or from selected fingers.