Confusion of Peripheral Arterial Doppler Waveform Terminology

Abstract

185Doppler instruments are widely used for the noninvasive evaluation of peripheral arterial disease. Auditory descriptors and graphic displays of waveforms characterize the hemodynamics of the vessel being examined. Descriptions of normal Characterization of peripheral arterial waveforms is basic to the diagnosis of vascular disease. Surveys indicate inconsistent application of traditional waveform descriptors. This study reviews literature to identify areas of confusion. Publications were reviewed to determine whether triphasic, biphasic, and monophasic terms were defined; if biphasic was linked with diastolic flow reversal; whether pandiastolic flow was associated with biphasic or monophasic terminology; and whether waveform illustrations had a zero baseline. Ninety-four publications were reviewed. Triphasic and monophasic were defined in 81%, biphasic in 48%. Biphasic was classified with flow reversal in 38%. Pandiastolic flow was not addressed in 57% but associated with monophasic in 47% and biphasic in 5%. Twenty-one percent of the publications had an illustration without a zeroflow baseline. This review suggests a lack of consensus when classifying arterial blood flow with traditional waveform descriptors. Waveform characterization inconsistencies are undermining comprehension of Doppler principles and may lead to inappropriate testing. A multisocietal consensus panel should accept responsibility for resolving this issue.

Statement for Doppler waveforms analysis

“…Regarding ABI, a certain number of measurements must be recorded to build up competence [6,39,40]. Studies conducted by Scissons highlight a better system for classifying Doppler waveform morphologies with the person gaining experience with every waveform analysis [8,10]. Studies should be carried out to establish the best way of teaching arterial waveform analysis and to improve practices for better patient management.…”

“…Amongst these, we refer to the classifi cations of Descotes and Cathignol [35] and Spronk et al [36] which off er a clear defi nition and illustration of the various types, information that are lacking in many publications [8]. However, neither of these two classifi cations proposes a "no-fl ow" phase, which may pose problems in the description of arterial haemodynamics.…”

“…However, although this practice of recording Doppler signal waveforms is extremely widespread, considerable disparity ex-fi ned. Out of 94 publications analysed, 81 % provided a defi nition of a triphasic or monophasic Doppler waveforms morphology and 38 % defi ned a biphasic Doppler waveforms morphology [8]. Representations of the various waveforms, when provided, are equally problematic since a Doppler waveform morphology described with the same name may have a diff erent waveforms morphology [11].…”

Arterial Doppler Waveforms

“…[1][2][3][4] For years, physicians and sonographers have asked, "How can a waveform be described by vascular professionals in so many different ways?" "Are there reference sources that correctly characterize arterial Doppler waveforms?…”

Characteristics of Pressure and Flow in Arteries and Veins: The Application to Noninvasive Peripheral Vascular Testing

“…3 The lack of return to forward fl ow is seen frequently in older persons and in arteries <2 mm (e.g., the distal tibials). The reverse fl ow component is initiated at the aortic root during early diastole, where a small backwards fl ow is seen.…”