Doppler evaluation of the pedal arch

The association of a patent pedal arch with early distal bypass patency has recently been emphasized. Unfortunately, in many patients information about the pedal arch can only be obtained with intraoperative angiography. An 8 mHz Doppler probe was used to noninvasively evaluate the pedal arch in 62 patients with various degrees of vascular disease. The probe was placed in the first metatarsal space, and the presence of a Doppler signal was taken as evidence of a patent pedal arch. Digital pressure was then applied over each tibial artery at the malleolar level to determine each vessel's communication with the pedal arch. Fifty-two patients were found to have patent pedal arches, while 10 did not. Preoperative hyperemic angiography or intraoperative arteriography was used to study the pedal arch in 22 of these patients. The arteriographic and Doppler findings were the same in 21 of 22 cases (96 percent accuracy). In the one case in which the results conflicted, the Doppler examination also gave information about which calf vessel contributed the most flow to the pedal arch. Preoperative Doppler evaluation of the foot combined with arteriography allows better selection of patients for distal bypass grafts.