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Segmental pressure and air plethysmography waveform (APW) analyses are widely used for noninvasive diagnosis of lower extremity peripheral arterial disease (PAD). The contribution of APW analysis to the diagnosis of PAD at the common femoral artery level or above (INFLOW) has been minimally assessed. This study examines APW characteristics in the thigh to determine which features best identify flow-limiting (&gt;50% diameter) INFLOW disease. Nondiabetic vascular laboratory patients with segmental APW analysis, systolic pressure measurements, and arteriography within 30 days of their noninvasive vascular ultrasound procedure were included for study. Thigh plethysmographic waveforms were evaluated for acceleration time (TIME) from onset of systole to peak systole, relative amplitude reduction (RAR) one-fifth of a second after peak systole, and waveform downslope curvature (CURV). Patients with nonsignificant INFLOW disease were defined by thigh plethysmography waveforms with inward CURV regardless of TIME or with TIME  0.28 seconds and outward or even CURV. Sensitivity for defining INFLOW disease was 94% (15/16) and specificity 81% (26/30); positive predictive value was 79% (15/19) and negative predictive value 96% (26/27). Thigh-level APW characteristics may improve identification of INFLOW disease in nondiabetic patients undergoing physiologic testing for lower extremity PAD.

Objective Lower Extremity Arterial Plethysmographic Waveform Characteristics for Differentiating Significant Inflow Disease in Nondiabetic Patients