Arterial Doppler Imaging, ABI, and Plethysmography

Excerpt

Peripheral arterial disease (PAD) is on the rise in the United States due to our aging population and the persistence of risk factors, including diabetes, hypertension, and obesity.

As patients present with suspected PAD, it is critical to obtain a full history and physical exam. Based on clinical findings, some patients may warrant diagnostic studies to further localize and quantify the severity of the disease. Non-invasive studies are a valuable adjunct for PAD assessment, particularly for lower extremity arterial disease.

The following article will discuss arterial Doppler, plethysmography, and pulse-volume recording (PVR). Given the safety, ease, and relative rapidity of the following exams, these assessments establish a baseline measurement trend over time. Based on these noninvasive findings, clinicians can pursue further studies and invasive procedures.

The ankle-brachial index (ABI) and arterial duplex imaging are also typical non-invasive tests to evaluate vascular disease, which have been described in previous articles.

While there can be variability between healthcare systems, it is common practice at our institution to order bilateral arterial doppler imaging with ABI's with Photoplethysmography (PPG) and segmental toe pressures with PVR for the initial evaluation of a patient with clinical findings suspicious for lower extremity peripheral arterial disease. These diagnostic studies are not required for all patients with vascular disease. Still, they should be considered in patients with reasonable suspicion of undiagnosed arterial disease or patients with progression of a known disease.