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Toe pressure and ABI

Toe pressure measurements and Ankle Brachial Index (ABI) are objective vascular tests used to confirm Peripheral Arterial Disease (PAD) and Critical Limb Ischemia (CLI) as well as to assess severity of disease, or evaluate treatments.

Many guidelines recommend objective vascular testing in all patients suspected of having Peripheral Arterial Disease (PAD). Visual inspection of the feet and palpable pulses have low specificity as diagnostic methods and, in addition, two thirds of all patients with PAD are asymptomatic or have atypical leg symptoms.

Ankle pressure and the Ankle Brachial Index (ABI) are the most common vascular tests used to diagnose PAD. Their diagnostic accuracy is unfortunately limited in patients with incompressible arteries (diabetes, end-stage renal disease, Critical Limb Ischemia), resulting in falsely elevated ABI values. Toe pressures have proven to be a better option in these patients.

Both ankle pressure and toe pressure are measured in the same way, but as the toe arteries are smaller, accurate detection of toe pressures require more precise techniques. Both the PeriFlux 6000 and the PeriFlux System 5000 use laser Doppler for detection and include a unique local heating feature, assuring excellent sensitivity. Different sized cuffs and small probes make it possible to measure on all toes. 

The procedure in short:

1.    Attach correct sized cuffs on toes, ankles and reference arm.
2.    Place laser Doppler probes on toes and reference arm.
3.    Inflate cuffs above systolic pressure to occlude the vessels.
4.    Deflate the pressure linearly.
5.    The pressure is detected when the blood returns to the vessels.

The PeriFlux System 5000 is not available within the EU and the EEA.

Practical hands on

Practical know how on how to perform peripheral pressure measurements such as toe pressure measurements, ABIs and PVRs.

Interpreting data

Data is not always perfect.  Useful information to aid in the interpretation of results:


Regular cleaning and disinfections of probes and cuffs is important.


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Improving quality of life since 1981

Perimed AB, established in 1981, provides instruments, software and expertise to enable assessment of the microcirculation. We utilize laser Doppler, laser speckle (LASCA) and transcutaneous oxygen (tcpO2 or TCOM), to accurately monitor and quantify blood perfusion and tissue oxygenation in real-time. Our modular PeriFlux System 5000 and PeriFlux 6000, the latest generation of our PeriFlux System, are excellent choices for diagnosing Peripheral Arterial Disease (PAD) and Critical Limb Ischemia (CLI) or for assessing wound healing potential in your vascular patients. Our blood perfusion imager PeriCam PSI System allows you to investigate spatial distribution, for example during cortical spreading depression.