1. Pressure cuffs are positioned around the upper and lower thigh and the upper and lower calf. The segments have been designated high thigh (HT), above-knee (AK), below-knee (BK), and ankle (A). Most commonly, cuffs of 10 to 12 cm in diameter with expandable bladders long enough to encircle the extremity are used (3).

2. Doppler signals are detected in either the dorsalis pedis or the posterior tibial artery.

3. Each blood pressure (BP) cuff is inflated in turn, and the systolic pressure determines when a Doppler signal is detected in the dorsalis pedis or posterior tibial branch.

4. A systolic BP measurement is taken from both arms at the brachial artery. By convention, the higher of the two systolic pressure values is used to calculate the pressure index for both legs. A difference of greater than 10 mm Hg in the systolic pressures should prompt an investigation of the upper extremities.

5. A ratio is constructed between the peak systolic pressure measured during deflation of the ankle cuffs and the systolic brachial pressure: the ankle-brachial index (ABI).

6. Stress testing is essential when evaluating claudication because exams at rest may be near normal.

a. Stress testing is performed with the patient walking on a treadmill with a 12-degree incline, moving at 2 miles per hour. BP cuffs are placed on the ankles. Electrocardiogram (ECG) monitoring is performed during stress.

b. The patient exercises for 5 minutes or until the symptoms are reproduced. Sequential ankle pressures are measured at 30-second intervals for the first
4 minutes and then every minute until the pressure measurement returns to normal or to the pre-exercise level (3).