Open Access Highly Accessed Research article

Flow mediated dilation of the brachial artery: an investigation of methods requiring further standardization

Alon Peretz1, Daniel F Leotta2, Jeffrey H Sullivan1, Carol A Trenga1, Fiona N Sands1, Mary R Aulet1, Marla Paun3, Edward A Gill4 and Joel D Kaufman156*

Author Affiliations

1 Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA

2 Department of Surgery, (Vascular Surgery) University of Washington, Seattle, Washington, USA

3 Applied Physics Laboratory, University of Washington, Seattle, Washington, USA

4 Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA

5 Department of Medicine, University of Washington, Seattle, WA, USA

6 University of Washington Occupational and Environmental Medicine Program, Department of Environmental and Occupational Health Sciences, 4225 Roosevelt Way NE, Suite #302, Box 354695 Seattle, WA 98195 USA

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BMC Cardiovascular Disorders 2007, 7:11  doi:10.1186/1471-2261-7-11

Published: 21 March 2007



In order to establish a consistent method for brachial artery reactivity assessment, we analyzed commonly used approaches to the test and their effects on the magnitude and time-course of flow mediated dilation (FMD), and on test variability and repeatability. As a popular and noninvasive assessment of endothelial function, several different approaches have been employed to measure brachial artery reactivity with B-mode ultrasound. Despite some efforts, there remains a lack of defined normal values and large variability in measurement technique.


Twenty-six healthy volunteers underwent repeated brachial artery diameter measurements by B-mode ultrasound. Following baseline diameter recordings we assessed endothelium-dependent flow mediated dilation by inflating a blood pressure cuff either on the upper arm (proximal) or on the forearm (distal).


Thirty-seven measures were performed using proximal occlusion and 25 with distal occlusion. Following proximal occlusion relative to distal occlusion, FMD was larger (16.2 ± 1.2% vs. 7.3 ± 0.9%, p < 0.0001) and elongated (107.2 s vs. 67.8 s, p = 0.0001). Measurement of the test repeatability showed that differences between the repeated measures were greater on average when the measurements were done using the proximal method as compared to the distal method (2.4%; 95% CI 0.5–4.3; p = 0.013).


These findings suggest that forearm compression holds statistical advantages over upper arm compression. Added to documented physiological and practical reasons, we propose that future studies should use forearm compression in the assessment of endothelial function.