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. 2025 Jan 9;7(2):113-121.
doi: 10.1253/circrep.CR-24-0046. eCollection 2025 Feb 10.

Usefulness of Blood Flow Measurement Device Using Bioelectrical Impedance Plethysmography in Lower-Extremity Artery Disease

Shigeo Horinaka  1 , Masashi Sakuma  1 , Yutaka Yonezawa  1 , Manami Watahiki  1 , Chika Higano  1 , Shigeru Toyoda  1 , Tomoyuki Yamamoto  2
Affiliations

Usefulness of Blood Flow Measurement Device Using Bioelectrical Impedance Plethysmography in Lower-Extremity Artery Disease

Shigeo Horinaka et al. Circ Rep. .

Abstract

Background: Bioelectrical impedance plethysmography (IPG) for measuring human body fraction and disease has been progressing in the past half-century, and few studies have reported lower-extremity arterial disease (LEAD) in recent years.

Methods and results: The present study enrolled patients who underwent examinations for LEAD. IPG with venous occlusion was performed, and flow volumes were compared with those measured using Doppler duplex ultrasonography, the ankle-brachial index (ABI), and assessments of arterial stenosis and collaterals using computed tomography and/or magnetic resonance angiographies. Fifty patients suspected of LEAD were enrolled; 15 had no arterial stenosis and 35 had LEAD. Arterial blood flow volume (BFV) was assessed. Although the area under the curve for IPG-BFV and Doppler-BFV in the popliteal artery with arterial stenosis were similar, IPG-BFV exhibited better diagnostic accuracy than Doppler-BFV (accuracy 0.765 and 0.694, respectively; McNemar's test P<0.01). In the analysis of covariance with IPG-BFV adjustment, Doppler-BFV was significantly lower in patients with LEAD (ABI<0.9), and morphological arterial stenosis, particularly in those with collaterals than in those without (F-test P<0.05, respectively).

Conclusions: IPG-BFV could have a better ability to discern the presence of arterial stenosis compared with Doppler-BFV and might not be confounded by the presence of collateral circulation when assessing blood flow in the entire lower extremity, which could be an advantage of IPG-BFV.

Keywords: Ankle-brachial index; Duplex Doppler ultrasonography; Impedance plethysmography; Lower-extremity arterial disease; Lower-extremity flow volume.

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Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this article.

Figures

Figure 1.
Figure 1.
Diagram of the paired current and potential electrodes and the pneumatic thigh cuff connected to the monitor. Data are stored in VaSera VS-2000 through the impedance device (IPU-100).
Figure 2.
Figure 2.
An alternating current of 100 μV at every 10 Hz, ranging from 30 to 120 Hz, is applied to the outer pair of electrodes. The impedance waveforms in the inner pair of electrodes are presented at each frequency. An upward deflection of the waveform represents decreased impedance caused by increased blood volume in 1 heartbeat.
Figure 3.
Figure 3.
Typical time-cause impedance tracing during venous occlusion plethysmography. The upper tracing represents increased blood volume, which corresponds to decreased impedance. The lower tracing represents the pneumatic cuff pressure.
Figure 4.
Figure 4.
Correlation between the blood flow volume (BFV) measured using duplex Doppler ultrasonography in the popliteal artery and that measured using bioelectrical impedance plethysmography (IPG) for the below-knee segment. The open and closed circles indicate the values of the leg without (n=51) and with (n=34) arterial stenosis, respectively.
Figure 5.
Figure 5.
Per-patient receiver operating characteristic curves for the lower-extremity arterial blood flow volume (BFV) measured with impedance plethysmography (IPG) and duplex Doppler ultrasonography in the popliteal artery of patients with arterial stenosis on computed tomography angiography or magnetic resonance angiography. AUC, area under the curve.
See this image and copyright information in PMC

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