Segmental Doppler Pressures and Doppler Waveform Analysis in Peripheral Vascular Disease of the Lower Extremities
DOI: 10.1007/978-1-84882-955-8_3 In book: Noninvasive Vascular Diagnosis, pp.25-38
The credit for first developing Doppler flow detectors belongs to Satomura, whose clinical report appeared in 1959.1 However, until Strandness et al.
2 popularized the use of transcutaneous flow detection to study peripheral vascular occlusive disease, the diagnosis or objective
assessment of limb ischemia was dependent upon clinical examination, arteriography, or plethysmography. The development of
the continuous-wave or pulsed Doppler techniques opened a new field for the diagnosis of peripheral vascular occlusive disease.
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ABSTRACT: Background: Patients treated for peripheral arterial occlusive dis- ease with lower limb revascularization (angioplasty or grafts) were fol- lowed up for a 2-year period after treatment with vascular ultrasound (segmental spectrum analysis, SSA). Objective: To demonstrate that SSA can be used in the follow-up of patients treated for peripheral arterial occlusive disease. Methods: The following SSA measurements were performed: peak systolic velocity (PSV), pulsatility index (PI), and flow velocity waveform (FVW). These measurements were performed and compared for each patient during the pre- and post-treatment periods (with 3-month intervals) for diagnosis of vascular patency. Results: Measurements performed postoperatively in the arteries immediately distal to the treated segments showed a significant increase in PSV and PI, with a change of the FVW from a monophasic to a biphasic or triphasic configuration. PSV and PI increased, respectively, 92.26 and 98.2% (intervention in the aortoiliac segment), 112.83 and 62.39% (intervention in the femoral-popliteal segment), and 149.08 and 28.8% (in the popliteal-tibial segment). Such changes in flow velocity patterns occurred in all patients and remained almost unaltered during the period of patient follow up. When treatment failed (hemodynamically significant occlusion or stenosis), parameters fell to levels similar to those observed prior to treatment. If treatment failure was corrected by new revascularization (angioplasty or grafts), SSA parameters returned to patterns observed after initial treatment. Conclusion: SSA can be used in the follow-up of patients with lower limb revascularization due to peripheral arterial occlusive disease, demonstrating treatment patency and failure.
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ABSTRACT: Analysis of continuous-wave Doppler waveforms acquired from peripheral arteries has been a cornerstone of vascular laboratory testing for decades. However, appropriate terminology for describing waveform morphology still remains controversial. Many clinicians classify waveforms on the basis of phasicity because it relates to waveform components that cross the zero baseline in the classic display. Others describe waveforms on the basis primarily of peripheral resistance and its effect on phasic directional changes on flow or on acceleration and deceleration of waveform parameters. Improved diagnostic efficacy may be achieved by combining all of the pertinent components of peripheral arterial waveforms when performing lower-extremity physiologic assessment. This article focuses on the classical use of qualitative peripheral arterial Doppler waveform descriptors with the use of continuous-wave Doppler.
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