From the Guidelines
The provided velocities from the arterial Doppler ultrasound of the lower extremity show normal flow patterns without significant stenosis, and therefore, no intervention is needed based on these findings. The common femoral artery velocity of 51.1 cm/s, superficial femoral artery velocities of 55 cm/s proximally and 34.3 cm/s distally, and popliteal artery velocity of 35 cm/s all fall within normal ranges, as stated in the 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases 1. Normal arterial velocities in the lower extremities typically range from 30-100 cm/s, with no significant velocity increases that would suggest stenosis. A significant stenosis would typically show a doubling or tripling of velocity at the stenotic site compared to proximal segments. The gradual decrease in velocity from proximal to distal vessels is physiologically normal due to increasing distance from the heart and vessel branching.
Some key points to consider in the diagnosis of peripheral arterial disease (PAD) include:
- The presence of all 4 (right and left) posterior tibial and dorsalis pedis pulses on palpation is associated with low likelihood of PAD, as mentioned in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1
- Evaluating for both abdominal and femoral bruits may also be useful to identify signs of PAD
- Other findings, such as elevation pallor/dependent rubor, asymmetric hair growth, and calf muscle atrophy, may be suggestive of PAD
- Additional evaluation for peripheral neuropathy should be considered among patients with diabetes
It is also important to consider alternative diagnoses for leg pain or claudication not related to PAD, 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 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1. However, based on the provided velocities, no further intervention is needed at this time, and regular follow-up with vascular studies would be recommended only if the patient develops symptoms such as claudication, rest pain, or tissue loss, or if they have significant risk factors for peripheral arterial disease progression.
From the Research
Artery Velocities Comparison
- The given velocities for CFA, SFA, Popliteal Artery, PTA, and DPA are being compared to a reference value or previous reading "visualiza 35".
- The velocities are:
- CFA: 51.1 cm/s
- SFA (proximally): 55 cm/s
- SFA (distally): 34.3 cm/s
- Popliteal Artery: 35 cm/s
- There is no direct information in the provided studies to compare these velocities to the reference value "visualiza 35" or to determine their clinical significance.
Peripheral Artery Disease (PAD) Management
- The management of PAD involves antiplatelet therapy, with aspirin being the most commonly used drug 2, 3, 4, 5.
- The efficacy of aspirin in PAD patients is uncertain, and new anti-platelet drugs such as prasugrel, ticagrelor, and picotamide may be more effective 2.
- Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin does not provide benefit over single antiplatelet therapy (SAPT) with aspirin alone and is associated with increased risk of major bleeding 4, 5.
- Rivaroxaban (2.5 mg b.i.d.) plus aspirin (100 mg daily) has been shown to reduce total mortality and cardiovascular mortality in PAD patients 4, 5.
Treatment Strategies for SFA Occlusions
- Treatment modalities for extensive chronic occlusive disease of the SFA include endoluminal therapy, percutaneous transluminal angioplasty, and surgical bypasses 6.
- Patency rates of percutaneous transluminal angioplasty combined with covered stents are within reach of patency rates of prosthetic surgical bypasses 6.
- Drug-bonding in surgical PTFE bypasses has increased patency rates significantly, and drug-eluting and drug-bonded devices may further improve results of endovascular treatment 6.