Magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) can also provide an accurate anatomic assessment of lower extremity arterial disease without some of the risks associated with catheter arteriography. The aorta is followed distally to its bifurcation, which is visualized by placing the transducer at the level of the umbilicus and using an oblique approach (Figure 17-4). These are readily visualized with color flow or power Doppler imaging and represent the geniculate and sural arteries (see Chapter 11 ). Volume flow in the common femoral artery was 434.4 mL/min; superficial femoral artery, 172.5 mL/min; popliteal artery, 92.1 mL/min; dorsalis pedis artery, 11.8 mL/min; and common plantar artery, 12.0 mL/min. Loss of triphasic waveforms, presence of spectral broadening, and post stenotic turbulence are signs of significant stenosis. Catheter contrast arteriography has generally been regarded as the definitive examination for lower extremity arterial disease, but this approach is invasive, expensive, and poorly suited for screening or long-term follow-up testing. R-CIA, right common iliac artery; L-CIA, left common iliac artery. Both color flow and power Doppler imaging provide important blood flow information to guide pulsed Doppler interrogation. Although an angle of 60 degrees is usually obtainable, angles below 60 degrees can be utilized to provide clinically useful information. In obstructive disease, waveform is monophasic and dampened. Stenosis Caused by Suture-Mediated Vascular Closure Device in an Angiographic Normal Common Femoral Artery: Its Mechanism and Management. Similar to the other arterial applications of duplex scanning, the lower extremity assessment relies on high-quality B-mode imaging to identify the artery of interest and to facilitate precise placement of the pulsed Doppler sample volume for spectral waveform analysis. The flow pattern in the center stream of normal lower extremity arteries is relatively uniform, with the red blood cells all having nearly the same velocity. adults: <3 mm. An electric blanket placed over the patient prevents vasoconstriction caused by low room temperatures. Monophasic flow: Will be present approach an occlusion (or near occlusion). The reverse flow component is also absent distal to severe occlusive lesions. Sandgren T, Sonesson B, Ryden-Ahlgren, Lnne T. J Vasc Surg. As discussed in Chapter 14, the nonimaging or indirect physiologic tests for lower extremity arterial disease, such as measurement of ankle systolic blood pressure and segmental limb pressures, provide valuable physiologic information, but they give relatively little anatomic detail.7 Duplex scanning extends the capabilities of indirect testing by obtaining anatomic and physiologic information directly from sites of arterial disease.

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