Selective arteriography is therefore often used as a confirmatory modality when PAES is suspected on cross- sectional imaging or US [7,16]. US Duplex Doppler Lower Extremity US duplex Doppler is heavily relied upon in the initial workup of PAES, where real-time visualization of flow occlusion and changes in segmental Doppler pressures upon provocative plantar flexion is crucial in confirming a suspected diagnosis [16,18]. This is extremely beneficial in the setting of functional PAES, where lack of an anatomic abnormality limits the sensitivity of cross-sectional modalities like CTA and MRA [18]. In PAES patients treated with popliteal bypass, US duplex Doppler is the first-line modality of choice in assessing graft patency; CTA, MRA, and selective arteriography are reserved for postoperative patients with abnormal US duplex Doppler examinations [17]. Several studies have found the use of US in the diagnosis of PAES to be potentially problematic, as the necessary use of transducer pressure applied during the examination may result in velocity changes that are difficult to interpret [7]. Provocative maneuvers may also shift the popliteal artery out of the Doppler region of interest, giving the artifactual appearance of occlusion [7,8]. US duplex Doppler has been found to have a particularly high false-positive rate in the workup of PAES, especially in athletes [5]. MRA is recommended to confirm the etiology of PAES in patients with a positive US duplex Doppler study and in patients with a negative US duplex Doppler study with a high index of clinical suspicion. US Intravascular Lower Extremity The use of intravascular US (IVUS) has been reportedly beneficial in confirming and assessing extent of popliteal artery compression in PAES. IVUS is often used as a confirmatory modality when PAES is suspected on cross- sectional imaging.
Nonatherosclerotic Peripheral Arterial Disease. Selective arteriography is therefore often used as a confirmatory modality when PAES is suspected on cross- sectional imaging or US [7,16]. US Duplex Doppler Lower Extremity US duplex Doppler is heavily relied upon in the initial workup of PAES, where real-time visualization of flow occlusion and changes in segmental Doppler pressures upon provocative plantar flexion is crucial in confirming a suspected diagnosis [16,18]. This is extremely beneficial in the setting of functional PAES, where lack of an anatomic abnormality limits the sensitivity of cross-sectional modalities like CTA and MRA [18]. In PAES patients treated with popliteal bypass, US duplex Doppler is the first-line modality of choice in assessing graft patency; CTA, MRA, and selective arteriography are reserved for postoperative patients with abnormal US duplex Doppler examinations [17]. Several studies have found the use of US in the diagnosis of PAES to be potentially problematic, as the necessary use of transducer pressure applied during the examination may result in velocity changes that are difficult to interpret [7]. Provocative maneuvers may also shift the popliteal artery out of the Doppler region of interest, giving the artifactual appearance of occlusion [7,8]. US duplex Doppler has been found to have a particularly high false-positive rate in the workup of PAES, especially in athletes [5]. MRA is recommended to confirm the etiology of PAES in patients with a positive US duplex Doppler study and in patients with a negative US duplex Doppler study with a high index of clinical suspicion. US Intravascular Lower Extremity The use of intravascular US (IVUS) has been reportedly beneficial in confirming and assessing extent of popliteal artery compression in PAES. IVUS is often used as a confirmatory modality when PAES is suspected on cross- sectional imaging.