Noninvasive Physiologic Vascular Studies: A Guide to Diagnosing Peripheral Arterial Disease

Abstract

Noninvasive physiologic vascular studies play an important role in the diagnosis and characterization in peripheral arterial disease (PAD) of the lower extremity. These studies evaluate the physiologic parameters of blood flow through segmental arterial pressures, Doppler waveforms, and pulse volume recordings. Collectively, they comprise a powerful toolset for defining the functionality of the arterial system, localizing the site of disease, and providing prognostic data. This technology has been widely adopted by diverse medical specialty practitioners, including radiologists, surgeons, cardiologists, and primary care providers. The use of these studies increased substantially between 2000 and 2010. Although they do not employ imaging, they remain a critical component for a comprehensive radiologic vascular laboratory. A strong presence of radiology in the diagnosis of PAD adds value in that radiologists have shifted to noninvasive alternatives to diagnostic catheter angiography (DCA), such as computed tomography (CT) and magnetic resonance (MR) angiography, which provide a more efficient, less-expensive, and lower-risk alternative. Other specialties have increased the use of DCA during the same period. The authors provide a review of the relevant anatomy and physiology of PAD as well as the associated clinical implications. In addition, guidelines for interpreting the ankle-brachial index, segmental pressures, Doppler waveforms, and pulse volume recordings are reviewed as well as potential limitations of these studies. Noninvasive physiologic vascular studies are provided here for review with associated correlating angiographic, CT, and/or MR findings covering the segmental distribution of PAD as well as select nonatherosclerotic diagnoses. RSNA, 2016.

The diabetic foot ulcer

“…15 An absolute toe pressure exceeding 30 mmHg is required for normal wound healing; however, for patients with diabetes, an ABI <0.7 or toe pressure <30-40 mmHg in the presence of a wound warrants a vascular surgical consultation. 10,12,16 These are measures of poor arterial perfusion and are associated with impaired wound healing. 12,16 Asymptomatic PVD (no claudication or ulceration) in a person with diabetes can be managed by observation.…”

“…10,12,16 These are measures of poor arterial perfusion and are associated with impaired wound healing. 12,16 Asymptomatic PVD (no claudication or ulceration) in a person with diabetes can be managed by observation.…”

Functional Assessment of Intermediate Vascular Disease

“…ABI is also not applicable in cases with noncompressible vessels and in some cases with proximal peripheral artery disease with good distal collateralization. Options to solve the problems are exercise oximetry and exercise near-infrared spectroscopy [ 78 , 79 ]. The clinical significance of an intermediate peripheral vascular stenosis depends on its localization, collateralization, and the flow reserve of the underlying skeletal muscles at maximal vasodilatation during exercise or with adenosine infusion [ 76 ].…”

Impact of an Educational Intervention on Ankle–Brachial Index Performance Among Medical Students and Fidelity Assessment at Six Months

“…Peripheral Arterial Disease (PAD) is a highly debilitating disease that affects 202 million people around the world and about 7 million people in France (1) . Noninvasive physiologic vascular studies such as the ankle-brachial index (ABI; ratio of the highest systolic blood pressure measured at the ankle to that measured at the brachial artery) at rest play an important role in the diagnosis and characterization in PAD of the lower extremity (2) . ABI is a quick and cost-effective examination in primary care and should be used to screen patients meeting the Trans-Atlantic Inter-Society Consensus Document on Management of PAD (TASC) II criteria (3) .…”