US Peripheral duplex ultrasound (DUS) imaging, which consists of grayscale 2-D imaging, color Doppler, and spectral waveform analysis, has been a mainstay of vascular imaging for decades. This technology is widely available, portable, does not require contrast agents, and can be used in the angiography suite or operating room. DUS has been validated as a screening tool [15], a first-line study for clinically suspected PAD [16], and as a tool to plan the approach for both endovascular and surgical intervention [17]. In most situations, it is complimentary to NIVT, such as the ABI [18]. US has a high sensitivity for the detection of patent tibial arteries but is less accurate in detecting complete occlusions, particularly in the peroneal artery [19]. DUS has also been used to quantify the firmness of occlusions to determine the degree of chronicity to some success [20]. Lower Extremity Arterial Revascularization correlate well with symptom recurrence [26]. When planning interventions, the anticipated intervention based on US alone was unchanged after angiogram in femoropopliteal and iliac lesions in >80% of patients, but only 59% in lesions below the knee [27]. In critical limbs, close surveillance shows significant improvement in limb salvage rates over clinical follow-up alone [28]. Unfortunately, of all the noninvasive imaging techniques, US is also the most operator dependent and time consuming [29]. The DIPAD trial, which evaluates the cost-benefit ratio of DUS compared with computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CE-MRA), showed that although the initial cost of US is lower, this does not take into account the time-related expense and operator experience required to produce satisfactory imaging. Additionally, practitioner confidence in the results is often lower than with the more advanced techniques, leading to a greater number of follow-up studies prior to intervention [30].
Lower Extremity Arterial Revascularization Post Therapy Imaging. US Peripheral duplex ultrasound (DUS) imaging, which consists of grayscale 2-D imaging, color Doppler, and spectral waveform analysis, has been a mainstay of vascular imaging for decades. This technology is widely available, portable, does not require contrast agents, and can be used in the angiography suite or operating room. DUS has been validated as a screening tool [15], a first-line study for clinically suspected PAD [16], and as a tool to plan the approach for both endovascular and surgical intervention [17]. In most situations, it is complimentary to NIVT, such as the ABI [18]. US has a high sensitivity for the detection of patent tibial arteries but is less accurate in detecting complete occlusions, particularly in the peroneal artery [19]. DUS has also been used to quantify the firmness of occlusions to determine the degree of chronicity to some success [20]. Lower Extremity Arterial Revascularization correlate well with symptom recurrence [26]. When planning interventions, the anticipated intervention based on US alone was unchanged after angiogram in femoropopliteal and iliac lesions in >80% of patients, but only 59% in lesions below the knee [27]. In critical limbs, close surveillance shows significant improvement in limb salvage rates over clinical follow-up alone [28]. Unfortunately, of all the noninvasive imaging techniques, US is also the most operator dependent and time consuming [29]. The DIPAD trial, which evaluates the cost-benefit ratio of DUS compared with computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CE-MRA), showed that although the initial cost of US is lower, this does not take into account the time-related expense and operator experience required to produce satisfactory imaging. Additionally, practitioner confidence in the results is often lower than with the more advanced techniques, leading to a greater number of follow-up studies prior to intervention [30].