4-cuff Exam
4-Cuff Segmental Exam
The most comprehensive segmental pressure study — four cuff levels per leg provide precise localization of arterial occlusion from the aortoiliac segment down to the tibial level.
Sample Report
Maximum Localization Precision
The 4-cuff segmental exam adds a high-thigh cuff to the standard 3-cuff protocol, creating four pressure measurement points per leg: high thigh, low thigh, calf, and ankle. This additional level allows differentiation between aortoiliac and femoral-popliteal disease — a clinically important distinction for intervention planning.
A pressure gradient greater than 20 mmHg between adjacent levels localizes the occlusion between those two segments with high specificity. This exam is the standard of care in vascular labs for comprehensive PAD workup.
How It Works
Same supine resting protocol as the standard ABI. The Doppler probe stays at the ankle throughout — only the number of cuff positions increases.
Apply 4-Level Cuffs
Cuffs placed at high thigh, low thigh, calf, and ankle bilaterally. Doppler probe at the posterior tibial artery.
Pressures + PVR at All Levels
Each cuff inflated and deflated in sequence. Systolic pressure and PVR waveform captured at all four levels, both sides.
Pressure Map Generated
Software maps the pressure gradient across all four segments, clearly indicating which level shows hemodynamically significant disease.
When to Order This Exam
Complete PAD workup when localization is needed
Differentiating aortoiliac from superficial femoral artery disease
Pre-intervention or pre-surgical vascular assessment
Claudication with moderate-to-severe ABI impairment
Suspected multi-level occlusive disease
Vascular lab standard study — CPT 93923
Available On
The 4-cuff exam requires an 8-port multi-level Cuff-Link system.
Documents
- 4-Cuff Exam Procedure
- Sample 4-Cuff Report — full output example
Training Videos
Questions About This Exam?
Schedule a 30-minute consultation. We'll walk through the protocol, the report output, and which system fits your workflow.