RadteraLower Extremity Arterial Duplex
USNo contrastVascular
Indications
- Claudication / rest pain
- Suspected peripheral arterial disease
- Diminished pulses
- Pre/post bypass or stent surveillance
- Non-healing ulcer / suspected ischemia
- Pseudoaneurysm evaluation
Patient prep
- None (some labs prefer ABI prior); supine, leg externally rotated
Contrast
None / non-contrast
Technique
- Linear 5-7 MHz for superficial, curvilinear for deep/iliac segments
- Grayscale and color Doppler along arterial tree; spectral waveforms at intervals
- Spectral Doppler angle <=60 degrees; record PSV proximal and at stenoses; calculate velocity ratio across lesions
- Often paired with ankle-brachial index / segmental pressures
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Distal aorta / common iliac (as accessible) | Spectral + color | Waveform; PSV |
| 2 | Common femoral artery | Spectral + color | PSV; waveform |
| 3 | Superficial femoral artery (prox/mid/distal) | Spectral + color | PSV; velocity ratio at stenosis (>2:1 ~ >50%) |
| 4 | Profunda femoris | Spectral + color | Waveform |
| 5 | Popliteal artery | Spectral + color | PSV; aneurysm assessment |
| 6 | Tibial vessels (anterior tibial, posterior tibial, peroneal) | Spectral + color | Waveforms/patency |
| 7 | Any bypass graft / stent (if surveillance) | Spectral + color | Inflow, body, anastomoses, outflow |
Key points
- Normal peripheral arteries show triphasic (multiphasic) waveforms; monophasic/dampened waveforms indicate proximal disease
- A focal PSV ratio >2:1 across a lesion indicates >=50% stenosis
- Document waveforms at standard segments and at any focal velocity increase
- Correlate with ABI / segmental pressures; assess popliteal for aneurysm
References
• AIUM Practice Parameter for the Performance of Peripheral Arterial Ultrasound Examinations Using Color and Spectral Doppler Imaging
• ACR Appropriateness Criteria: Lower Extremity Arterial Claudication
• Radiopaedia: Peripheral arterial disease link
• ACR Appropriateness Criteria: Lower Extremity Arterial Claudication
• Radiopaedia: Peripheral arterial disease link
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.