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Noninvasive Vascular Diagnosis pp 319–336Cite as

Segmental Doppler Pressures and Doppler Waveform Analysis in Peripheral Vascular Disease of the Lower Extremities

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Abstract

Segmental Doppler pressures and Doppler waveform analysis are important tools in the diagnosis of patients with peripheral vascular disease of the lower extremities. A complete arterial lower extremity Doppler examination consists of three components: (1) analysis of the arterial analog wave tracing, (2) measurement of the segmental systolic limb pressures, and (3) calculation of the ankle-brachial index (ABI).

Doppler segmental pressures have the same capabilities of analog wave tracing, i.e., to help in identifying the presence and severity of arterial occlusive disease, to provide an objective baseline to follow the progression of peripheral vascular disease of the lower extremity and/or the postoperative course, and to somewhat evaluate the treatment plan.

Four 12 × 40 pneumatic cuffs are applied at various levels on each leg: as high on the thigh as possible, just above the knee, just below the knee, and above the ankle. The examiner then listens to the posterior tibial and the dorsalis pedis arterial signals. Of these vessels, the one with the strongest Doppler signal is chosen for the ankle pressure. High-thigh, above-knee, below-knee, and ankle pressure readings are taken.

Another component of the arterial lower extremity Doppler examination is the calculation of the ABI. It is generally agreed upon that an ABI of 0.9–1.0 signifies normalcy or minimal arterial occlusive disease, an ABI of 0.5–0.9 signifies a claudication level, less than 0.5 signifies the presence of ischemic rest pain or severe arterial occlusive disease, and less than 0.3 is compatible with trophic changes of the lower extremities.

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Author information

Authors and Affiliations

  1. Department of Surgery, Division of Vascular/Endovascular Surgery, West Virginia University/Charleston Division, 3110 MacCorkle Ave., SE, Charleston, WV, 25304, USA

    Stephen M. Hass MD, JD & Ali F. AbuRahma MD

Authors
  1. Stephen M. Hass MD, JD
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  2. Ali F. AbuRahma MD
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Corresponding author

Correspondence to Stephen M. Hass MD, JD .

Editor information

Editors and Affiliations

  1. Charleston, West Virginia, USA

    Ali F. AbuRahma

Review Questions

Review Questions

  1. 1.

    According to the most recent evidence-based medicine, which is the preferred initial noninvasive test to evaluate a patient for the presence of peripheral arterial disease?

    1. a.

      Segmental Doppler pressure measurements

    2. b.

      Duplex ultrasound

    3. c.

      Treadmill exercise testing

    4. d.

      Toe pressure measurements

    5. e.

      Ankle-brachial index

  2. 2.

    A diabetic patient presents with an ulcer on the first and second toes on the left foot. The initial ankle to brachial index result is 1.6. What is the next preferred noninvasive test?

    1. a.

      Duplex ultrasound

    2. b.

      Toe pressure measurement/toe-brachial index

    3. c.

      Segmental Doppler pressure measurements

    4. d.

      Treadmill exercise testing

  3. 3.

    A patient presents with significant claudication of less than one-half block. He has failed medical management and requires regular ambulation at his employment. He is also a mild diabetic with a history of lower back surgery. What would be the next ideal noninvasive evaluation if an intervention is being considered?

    1. a.

      Duplex ultrasound alone

    2. b.

      Ankle-brachial index alone

    3. c.

      Segmental pressure measurements including the ankle-brachial index

    4. d.

      Duplex ultrasound including the ankle-brachial index

  4. 4.

    Which patient would most likely benefit from treadmill testing?

    1. a.

      A 70-year-old nondiabetic male with bilateral lower extremity discomfort in his calves with ambulation less than one block, no positional or at rest discomfort in his lower extremities, and diminished ankle-brachial indices bilaterally

    2. b.

      An 81-year-old female with rest pain in her left foot and a severely diminished left ankle to brachial index.

    3. c.

      A 69-year-old diabetic male with disabling claudication in both legs, known lower extremity diabetic neuropathy, ankle-brachial indices of 0.95 on the right and 0.89 on the left, and a recent history of exertional angina

    4. d.

      A 63-year-old obese female with bilateral lower extremity fatigue and weakness with ambulation of less than one block, complaints of lower extremity and hip pain after standing for long periods of time, and ankle-brachial indices of 0.88 on the right and 0.86 on the left

Answer Key

  1. 1.

    e

  2. 2.

    b

  3. 3.

    d

  4. 4.

    d

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Hass, S.M., AbuRahma, A.F. (2017). Segmental Doppler Pressures and Doppler Waveform Analysis in Peripheral Vascular Disease of the Lower Extremities. In: AbuRahma, A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54760-2_22

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