Duplex Ultrasound Assessment of Lower Extremity Arterial Disease

Abstract

The clinical application of duplex ultrasound for the evaluation of lower limb arterial disease is the preferred diagnostic technique for both occlusive and aneurysmal conditions. Duplex imaging enhances the clinician’s acumen by providing detailed artery anatomy and physiology in both asymptomatic and symptomatic patients. Testing is performed under resting conditions and details regional arterial hemodynamics in the arterial segment imaged and interrogated using pulsed Doppler spectral analysis. Study interpretation uses criteria based on vessel imaging and Doppler waveform analysis; in conjunction with physiologic testing measurements of ankle-brachial systolic pressure index. Testing can be performed at the bedside and provide a timely diagnosis of arterial conditions, and guide either medical or procedural therapies. Duplex testing improved diagnostic accuracy and should be used to plan interventions and during patient follow-up as the surveillance method to identify disease progression and failing endovascular and arterial bypass procedure.

Review Questions

• 1. The duplex of the left common femoral artery (Fig. 24.10) suggests:

  • a. Normal left common femoral artery waveform and flow.

  • b. Moderate stenosis of left common femoral artery

  • c. Suspected left superficial femoral artery occlusion

  • d. Likely moderate to severe left iliac arterial stenosis

  • e. Left profunda femoris arterial occlusion

• 2. The benefits of lower arterial duplex scanning include all the following, except:

  • a. Provide relevant structural and hemodynamic information to guide endovascular and open surgical revascularization

  • b. Cost effective imaging comparable to other noninvasive angiography imaging techniques

  • c. Eliminates risk of radiation and contrast mediated bioeffects

  • d. Ideal for surveillance of endovascular or open surgical vascular interventions

  • e. All the above are benefits of arterial duplex ultrasound

• 3. This left femoral to popliteal artery bypass surveillance ultrasound (Fig. 24.11) shows:

  • a. Normal surveillance bypass scan

  • b. Retained valve distal bypass

  • c. Persistently patent vein side branch

  • d. Sclerotic segment distal vein bypass

  • e. Outflow stenosis at the distal anastomosis

• 4. Which of the following spectral criteria are consistent with a high grade stenosis of the superficial femoral artery?

  • a. Sharp systolic upstroke with breif reversal flow in diastole

  • b. Nondectable dorsalis pedis pulse

  • c. Loss of end systolic reversal of flow with a superfical femoral artery peak systolic velocity (PSV) >100% of the common femoral artery

  • d. Triphasic wavefrom with spectral broadening PSV of 150 cm/s

  • e. Monophasic commonfemoral artery waveforem with PSV >30% the superficial femoral artery

• 5. Duplex ultrasound in a patient with history of drug eluting balloon angioplasty of the distal superficial femoral artery (Fig. 24.12) suggests:

  • a. Distal arteriovenous fistula superficial femoral artery associated with endovascular intervention

  • b. Low resistance waveform pattern

  • c. Occluded below knee popliteal artery

  • d. High grade stenosis at the level of Hunter’s canal

  • e. Moderate stenosis superficial femoral artery with preserved diastolic flow

Fig. 24.10

Review Question #1—duplex scan image of common femoral artery flow

Fig. 24.11

Review Question #3—duplex scan image of an infrainguinal vein bypass

Fig. 24.12

Review Question #5—duplex scan image of lower limb arterial bypass

Answer Key

• 1. c

• 2. e

• 3. c

• 4. c

• 5. d