What is the significance of the peak systolic velocities in the Common Femoral Artery (CFA) at 51.1 cm/s, Superficial Femoral Artery (SFA) at 55 cm/s proximally and 34.3 cm/s distally, Popliteal Artery at 35 cm/s, Posterior Tibial Artery (PTA), and Dorsalis Pedis Artery (DPA) in comparison to a reference value of 'visualiza 35'?

From the Guidelines

The provided velocities for the lower extremity arteries appear to be within normal limits, suggesting no significant stenosis or need for intervention based on these values alone. The common femoral artery (CFA) velocity of 51.1 cm/s, superficial femoral artery (SFA) velocities of 55 cm/s proximally and 34.3 cm/s distally, popliteal artery velocity of 35 cm/s, along with measurements for the posterior tibial artery (PTA) and dorsalis pedis artery (DPA) are all within the expected range of 30-100 cm/s, as indicated by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1.

Key Points to Consider

• The gradual decrease in velocity from proximal to distal vessels is physiologically expected due to vessel branching and increasing peripheral resistance.
• Clinical correlation with symptoms and other findings is always recommended, as the differential diagnosis for leg pain or claudication is broad and may include conditions such as hip arthritis, foot/ankle arthritis, nerve root compression, spinal stenosis, symptomatic popliteal (Baker’s) cyst, venous claudication, and chronic compartment syndrome, as outlined in the 2024 guideline 1.
• Regular monitoring would be appropriate for patients with risk factors for peripheral arterial disease, including diabetes, smoking, hypertension, or hyperlipidemia.
• The presence of all four (right and left) posterior tibial and dorsalis pedis pulses on palpation is associated with a low likelihood of PAD, as noted in the 2024 guideline 1.

Recommendations

• No intervention is needed based on these velocity values alone.
• Clinical assessment and correlation with symptoms are crucial for determining the need for further diagnostic testing or intervention.
• Patients at increased risk of PAD should undergo a thorough vascular examination, including palpation of lower extremity pulses and evaluation for signs of PAD, such as abdominal and femoral bruits, elevation pallor/dependent rubor, asymmetric hair growth, and calf muscle atrophy, as recommended by the 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases 1 and the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1.

From the Research

Artery Velocities Comparison

• The given velocities for the Common Femoral Artery (CFA), Superficial Femoral Artery (SFA), Popliteal Artery, Posterior Tibial Artery (PTA), and Dorsalis Pedis Artery (DPA) are being compared to a reference value or previous reading "visualiza 35".
• The velocities are as follows:
  • CFA: 51.1 cm/s
  • SFA (proximally): 55 cm/s
  • SFA (distally): 34.3 cm/s
  • Popliteal Artery: 35 cm/s
• These values can be used to assess the blood flow and potential stenosis in the arteries.

Relevant Studies

• A study published in 2008 2 discusses antithrombotic therapy for peripheral artery occlusive disease, but does not provide specific information on artery velocities.
• A 2018 study 3 reviews antithrombotic treatment in peripheral artery disease, and mentions the use of aspirin and clopidogrel, but does not discuss artery velocities.
• A 2020 study 4 evaluates the use of duplex ultrasound for diagnosis of failing stents in lower extremity arterial occlusive disease, and discusses peak systolic velocities (PSVs) and ratio of adjacent PSVs (Vr), but does not provide specific velocity values for comparison.
• A 2019 study 5 discusses antithrombotics in stable peripheral artery disease, and mentions the importance of preventing major adverse cardiovascular events (MACE) and major adverse limb events (MALE), but does not provide information on artery velocities.
• A 2022 review article 6 provides an updated overview of peripheral artery disease, including its clinical course, diagnosis, and management, but does not discuss specific artery velocities.

Comparison to Reference Value

• The given velocities can be compared to the reference value "visualiza 35" to assess potential stenosis or abnormalities in blood flow.
• However, without more information on the reference value or previous reading, it is difficult to determine the significance of the given velocities.