Peripheral arterial Doppler ultrasonography: diagnostic criteria

Abstract

Fifty-one patients (86 legs) were studied from the aorta to the popliteal artery with both duplex ultrasonography and arteriography with the intention of establishing diagnostic ultrasonographic criteria for degrees of stenosis >50% and determining the effect of multisegment disease on the accuracy of these criteria. Receiver operator characteristic curves were used to determine diagnostic criteria for >50%, >70%, >90% diameter stenoses or occlusions. A stenosis of >70% was diagnosed either if the peak systolic velocity was more than 160 cm/sec (sensitivity 77%, specificity N o duplex criteria have been published to distinguish degrees of peripheral arterial stenosis of greater than 50%, and only a few articles describe criteria to distinguish stenosis below 50% from stenosis greater than 50% diameter. 1 -6 We examined a series of patients with both duplex ultrasonography and arteriography with the intention of establishing diagnostic criteria that would (1) allow a distinction to be made between degrees of stenosis of >50% diameter, and (2) show the effect, if any, of multisegment disease on the accuracy of these criteria. MATERIALS AND METHODSFifty-one patients scheduled for peripheral arteriography were also examined with duplex sonography prior to arteriography. 90%) of if there was an increase in peak systolic veloc· ity of 100% with respect to the arterial segment above the stenosis (sensitivity 80%, specificity 93%). Sequential stenoses were detected with lesser sensitivities. Ratio criteria were more accurate than peak systolic velocity for all degrees of stenosis. For detection of occlusion, duplex ultrasonography was 92% sensitive and 99% specific. KEY WORDS: Arteries, extremities; Arteries, stenosis; Arteries, ultrasound studies; Ultra• sound, Doppler studies.being evaluated for claudication (20/21 <2 blocks), 15 (29%) for rest pain, 11 (22%) for a nonhealing ulcer or gangrene, two (4%) for abdominal aortic aneurysms, one (2%) for acute ischemia, and one (2%) for PTA followup. Twenty-one of the 51 ( 41 % ) were diabetic. Patients were selected for the study on the basis of their willingness to undergo the sonographic examination and the ability to schedule it at a convenient time. An average delay of 2.5 days (range, 0 to 56 days) occurred between the time of duplex sonography and angiographic studies.Eighty-six legs in these 51 patients were evaluated with both duplex sonography and arteriography. Thirty-five patients scheduled for bilateral angiography were scanned from the distal aorta to distal popliteal artery bilaterally. Sixteen patients had unilateral arteriography and unilateral sonography from the external iliac artery to the popliteal artery.All sonographic examinations were performed with an Acuson 128 (Acuson, Mountain View, CA) using a 5 MHz linear array transducer. Occasionally, in large patients the aorta and iliac segments were examined using a 3 MHz sector transducer. The Doppler angle was maintained at 60 degrees or less. Doppler information was displayed in black and white. The w...

Potential Vascular Mechanisms of Ramipril Induced Increases in Walking Ability in Patients With Intermittent Claudication

“…Peak systolic velocity in lower limb vessel segments was measured to determine the grade of stenosis as previously described. 16 In 111 patients with femoral disease (50 on placebo and 61 on ramipril), we also determined volume flow. Femoral disease was classified as ≥50% stenosis but no occlusion in the common or superficial femoral arteries.…”

Pattern of Vascular Insufficiency on Ultrasound Colour Doppler and Computed Tomographic Angiography in Patients with Diabetic Foot and Its Clinical Outcome

“…Occlusion was present most commonly in posterior tibial arteries (30.77%), followed by anterior tibial artery (20%) and peroneal artery (13.1%). In the study by Sacks et al sixteen of 86 (19%) legs had no occlusion, whereas seventy of 86 (81%) legs had occluded segment in vessel [14].…”

“…The mean peak systolic was highest for common femoral artery (90.99 ± 28.6 cm/s) and lowest for dorsalis pedis artery (58.44 ± 39.59 cm/s). Sacks et al in their study observed the gradual decrease in peak systolic velocity from iliac to popliteal artery [14]. Resistance Index (RI) is a quantitative analysis of the waveform and reflects resistance to blood flow.…”

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

“…For patients who do not develop specific limb or cardiovascular symptoms, exercise may be terminated when patients achieve a high functional peak systolic velocity ratios have been found to be the most accurate diagnostic criterion. A ratio greater than 2 is commonly used to diagnose a stenosis greater than 50% diameter (201,202,205,207), although other ratios have been used (203,204,206,210). Some studies have attempted to further calibrate the duplex technique to distinguish between degrees of stenosis between 50% and 75% versus 75% and 99% (203,204,207,210).…”

“…Duplex ultrasound also has broad clinical utility for evaluation of aneurysms, arterial dissection, popliteal artery entrapment syndrome, evaluation of lymphoceles, and assessment of soft tissue masses in individuals with vascular disease. Although duplex ultrasound includes images, either in black and white or color format, the primary clinically relevant information derived from duplex studies has been validated from analysis of the velocity of blood flow (201)(202)(203)(204)(205)(206)(207)(208)(209). Quantitative criteria used to diagnose stenoses are based on peak systolic velocity and peak systolic velocity ratios within or beyond the stenosis compared with the adjacent upstream segment, the presence or absence of turbulence, and preservation of pulsatility.…”