The prediction of healing in ischemic lesions of the foot. A comparison of Doppler ultrasound and elevation reactive hyperemia

The results of the Elevation Reactive Hyperemia Test (ERHT) and the transcutaneous Doppler ultrasound ankle blood pressure (DAP) have been compared in a series of 115 cases with ischemic lesions of the foot. The ERHT was carried out by simple elevation of the foot or elevation with the circulation temporarily obstructed by a blood pressure cuff following which the foot was gradually lowered until the reactive hyperemia was seen in the skin and the height above the right atrium was estimated. The appearance of the hyperemia at 35 cm above the right atrium will allow healing of local ischemic lesions and at the height of 45 cm or above indicates a zone at which amputation may be carried out successfully. In the same series the DAP using 60 mmHg as the cut off point showed 40% healing with a pressure less than this level and 40% failed with a pressure above this level. The DAP gave no consistent prediction of the healing of ischemic lesions or of amputations.