![]() ![]() A velocity ratio > 4 suggests greater than 80% stenosis.įIGURE 3B: Arterial duplex image and spectral Doppler waveform of the distal superficial femoral artery, distal to the stenosis. A velocity ratio > 2 is consistent with greater than 50% stenosis. ![]() The velocity ratio (peak systolic velocity divided by the systolic velocity in the normal proximal segment) is elevated at 6.2. The peak systolic velocity is markedly elevated at 435 cm/s. Spectral Doppler waveforms distal to the stenosis are monophasic and display a tardus et parvus pattern with delayed upstroke and low velocity (FIGURE 3B).įIGURE 3A: Arterial duplex image and spectral Doppler waveform of the mid superficial femoral artery indicating hemodynamically significant stenosis. Spectral Doppler interrogation reveals elevated flow velocities at the site of (or just distal to) the stenosis, with a doubling of velocities compared to a more normal proximal segment suggestive of a hemodynamically significant lesion (FIGURE 3A). Arterial duplex allows for direct plaque visualization with assessment of hemodynamics to establish stenosis severity. Instead, it is typically obtained for more focused evaluation of the lower extremity arterial system such as localization of stenosis, assessment of stent or bypass graft patency, and detection of pseudoaneurysms or arteriovenous fistulas. ![]() However, it is time-consuming and operator dependent, and thus should not be used as the primary diagnostic tool for the detection of PAD. Arterial duplex ultrasonography is noninvasive and readily available in the vascular laboratory as a useful adjunct to non-invasive physiologic testing. ![]()
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