Journal for Vascular Ultrasound

—Segmental femoropopliteal duplex scanning in conjunction with ankle plethysmographic waveforms and ankle/brachial indices (ABI) was evaluated as an alternative to traditional physiologic testing for the initial vascular laboratory evaluation of patients with lower extremity peripheral arterial disease (PAD). To assess the potential of this evaluation, patients with PAD were evaluated in the vascular laboratory with (1) pulse volume recording and segmental pressures (SPVR) and (2) femoropopliteal duplex imaging with pulsed Doppler waveform analysis and bilateral ankle plethysmographic waveforms and ABI (SDuplex).

—SPVR and SDuplex data were prospectively obtained from 39 patients and 72 limbs. Separate technologists performed the physiologic and duplex examinations independently. Angiograms performed within 90 days were used as the gold standard for evaluating results from both procedures. Results from both examinations were interpreted for severe (>50% diameter reduction) inflow and superior femoral artery (SFA) disease. A McNemar test was performed on the SPVR and SDuplex paired data, and direct (hands-on) examination time was calculated for both procedures.

—Angiograms were available for 20 of 72 (28%) of the limbs evaluated and demonstrated no significant differences between both methods for evaluating inflow (femoral or above) disease, yet SDuplex was superior to SPVR for evaluating SFA disease. McNemar test data also suggested that SDuplex was superior to SPVR in diagnosing severe disease at the SFA level. The average time for SPVR examination performance was 28 minutes and 31 minutes for SDuplex with ABI and ankle waveforms.

—SDuplex was superior to SPVR for evaluating SFA disease. No noteworthy differences in direct (hands-on) examination times for both procedures suggest the additional benefit of enhanced reimbursement. With superior SFA accuracy, more site-specific information, and greater reimbursement potential, SDuplex should be considered an alternative to the traditional physiologic examination for evaluating patients with lower extremity PAD.

To describe the current Stanford duplex protocol for ultrasound scanning of abdominal aortic aneurysms after endovascular repair. This technique has been used for more than 7 years in the Stanford Vascular Laboratory and has been validated against computed angiography. It. provides quantitative information on aneurysm sac size and flow characteristics, as well as endograft patency and integrity.

—Abdominal aortic duplex scans are obtained after the patient has been fasting to minimize bowel gas. An internally standardized duplex scanning protocol is used for assessing the abdominal aorta. The aorta is imaged in gray scale from the diaphragm to the aortic bifurcation to determine the presence of wall defects and to measure the greatest diameter and circumference. Measurements are obtained from the largest segment of the supraceliac aorta, infrarenal aorta, and common iliac arteries. Additional measurements are obtained to document disease of the hypogastric or external iliac artery when not obscured by overlying bowel gas. Circumference measurements using calculation software tools available in most ultrasound equipment are also obtained to more easily monitor the morphologic changes in the aneurysm over time. Color and spectral Doppler are used to evaluate for potential extrastent flow. In addition, velocity waveforms are obtained from each limb to evaluate for changes suggesting potential stenosis from graft compression or outflow obstruction.

—Duplex ultrasound scanning after endovascular repair of abdominal aortic aneurysms can be used successfully to determine aneurysm size and presence or absence of extrastent flow in 94% of patients. Thus, this technique is applicable to most patients after endovascular repair.