الفهرس 
Physics of color-Doppler sonographyOnly 14 pages are availabe for public view
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Abstract
The nonnal anatomy of lower extremity artery tree was described, followed by pathogenesis, risk
factors and complication of atherosclerosis, clinical presentation and examination of a patient
with lower extremity atherosclerotic disease, basic physical principles of Doppler-Duplexand
color-duplex ultrasonography, artifacts of CDS, CDS examination technique and interpretation of its
results.
Each limb was divided into 9 ilio-femoro-popliteal (CIA, EIA, CFA, Prof. FA, prox. SFA, mid.
SFA, dist.SFA,
Prox. pop. A and dist pop. A and 6 infrapopliteal
segments, prox. and dist. halves of PTA, ATA and peroneal artery. CDS classified atherosclerotic
lesions in ilio femoro-popliteal segments into normal, hemodynamically nonsignificant (less than
50% DR), hemodynamically significant lesions (50-99% DR) and total occlusion (100%DR) while in
infrapopliteal segment, CDS classified segment into either patent or occluded.
We suggested that any patient with lower extremity atherosclerotic disease should be assessed
first by thorough clinical history and examination, ABI and CDS which maybe enough in
some patients especially when CDS . examination is negative due to its overall high NPV
96% while in remaining patients, CDS can identify specific segments for
arteriographic study allowing excellent arteriogram with attention to t11e diseased
segments with less examination time, less contrast media and consequently
less complication. Also preliminary CDS in cases of focal lesion can save the
patient a second arteriographic. study by preparing the radiologist before examination
for the possibility of percutaneous transluminal angioplasty (PTA) so that both
procedures are
performed in the same session. Furthermore, CDS guide the radiologist to the side, site and
number of lesions amenable to PTA and direction of catheter placement to avoid unfortunate
situation of finding another lesion amenable to PTA but having to reschedule the patient for a
second arteriographic study due to disadvantageous access site. Also preoperative CDS can identify
concomitent iliac artery focal significant lesion with diffuse femoropopliteal disease thus
allowing staged fashion management with PTA performed for the iliac lesion several days before
distal arterial reconstruction to improve inflow and consequently a successful bypass operation.
CDS is invaluable prior to infrainguinal arterial reconstruction not only in the assessment of
inflow and runoff but in saphenous vein mapping as well as CDS is invaluable for following the
results of intervention and it is the first practical accurate method for graft surveillance in
terms of time, cost, effort and reliability, increasing the cumulative assisted primary patency
rate to 96% at 1 year and 85% at 5 5’ears.
Color duplex ultrasonagraphy has the capability of providing anatomic and hemodynamic information
from the pelvic and lower extremity arteries down to the dorsalis pedis artery. The categorization
of lower extremity atherosclerotic disease by CDS has been shown to have the anatomic accuracy, of
arteriography in addition to providing direct hemodynamic information previously unobtainable by
noninvasive methods. selective integration of CDS as an adjunct to the clinical history, physical
examination and pressure measurements can provide precise information demonstrating the
morphology (stenosis versus occlusion) and location of arterial lesions to specific arterial
segment. These information can then be used to plan subsequent arteriography or interventional
procedures. The infonnation generated is reliable, cost
effective and accurate enough in many cases to allow intervention without confirmatory
arteriography as CDS provides enough precise information to obviate the need for arteriography ·in
certain instances and permit more selective use in others. Although, CDS will not completely
replace arteriography, it has assumed an important initial role in pre-angioplasty and
pre-operative evaluation. We recommend that CDS should become the standard modality for screening
patient with lower extremity atherosclerotic disease this eliminating unnecessary invasive
studies but we think that complete replacement of arteriography by CDS scanning, in lower
extremity arterial disease, is premature but both modalities are complementary to each other in
many patients and CDS replace arteriography in some situations .