Erica Brownfield, MD

Disclosures

March 26, 2004

Question

What is the proper technique for measuring blood pressure in the legs? How do standard readings in the legs compare with those obtained in the arms? How long is it necessary to avoid using a cuff on the arm following a mastectomy?

Debra K. Levin, MD

Response From the Expert

Erica Brownfield, MD

Blood pressure measurement in the legs is achieved with an appropriate-sized cuff, applied at the midthigh, and by listening over the popliteal artery. If possible, the patient should be in a prone position. The bladder of the cuff should be about 40% of the circumference of the thigh, and the length should be about 75% to 80% of this circumference.[1]

Normally, the systolic blood pressure in the legs is usually 10% to 20% higher than the brachial artery pressure. Blood pressure readings that are lower in the legs as compared with the upper arms are considered abnormal and should prompt a work-up for peripheral vascular disease. All hypertensive patients should have comparisons of arm and leg blood pressures as well as volume and timing of the radial and femoral pulses at least once to rule out coarctation of the aorta.[1]

Despite a lack of scientific evidence, it is recommended that patients who have undergone axillary node dissection avoid having blood pressure measurements done on the affected side. For those who have had bilateral axillary node dissection, blood pressure measurements should be obtained in the leg. For those patients who have had a mastectomy without lymph node dissection (ie, prophylactic mastectomy), blood pressure can be obtained in either arm. These recommendations should be followed for life.[2]

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