Arterial Duplex Imaging of Lower-Extremity Arteries and Interventions

Abstract

The application of duplex ultrasound for the evaluation of patients with lower-limb arterial occlusive disease provides the clinician with detailed information on its location, extent, and severity. Duplex scanning from the visceral aortic segment to the tibial arteries allows the detection of aneurysms and occlusive disease with a classification of its severity, including the presence of critical limb ischemia. Testing should be performed in conjunction with limb pressure measurements to accurately categorize arterial hemodynamics and functional impairment. Interpretation of duplex-acquired velocity spectra recordings is fundamental to successful clinical evaluation, including the characteristic features of normal versus and abnormal lower-limb arterial flow and hemodynamic changes associated with stenosis both at the occlusive lesions and its impact on distal limb perfusion. Duplex testing is accurate both before and after intervention for the diagnosis of occlusion and stenosis severity allowing decisions regarding treatment (medical, open surgical repair, endovascular therapy) to be made. Scanning can provide an arterial map of occlusive or aneurysm lesions analogous to magnetic resonance or computed-tomography angiography. An important duplex ultrasound application is for the surveillance of lower-limb bypass grafts and peripheral angioplasty for the development of stenosis that is their common mode of failure. The detection of high-grade stenosis in an arterial repair allows for pre-emptive treatment before thrombosis and improves long-term patency.