Doppler ultrasound - basics revisited

Abstract

Palpation of pedal pulses alone is known to be an unreliable indicator for the presence of arterial disease. Using portable Doppler ultrasound to measure the resting ankle brachial pressure index is superior to palpation of peripheral pulses as an assessment of the adequacy pf the arterial supply in the lower limb. Revisiting basics, this article aims to aid the clinician to understand and perform hand-held Doppler ultrasound effectively while involving the client or patient in the process. The author describes the basics of Doppler ultrasound, how to select correct equipment for the process, and interpretation of results to further enhance clinicians' knowledge.

Heel pressure ulcers on the increase? Epidemiological change or ineffective prevention strategies?

“…The cuff was then inflated until arterial flow ceased and the compression was reduced until the Doppler signal reappeared. For each subject an ankleebrachial pressure ratio was established [5]. Subjects were stratified into groups based on their measured ABPI e those who had no evidence of lower leg arterial blockage (ABPI 0.9e1.3), those with indicated mediacalcosis (ABPI over 1.3) and finally subjects with evident lower leg atherosclerosis (ABPI 0.9).…”

Commentary: Demystifying Doppler – revisiting a vital diagnostic tool

“…Generally in the lower limb, the Doppler probe is pointed up the limb towards the head of the patient (cephalad) and angled at approximately 45° [ 11 ]. Adequate water-based coupling gel should be used to conduct the signal [ 11 ].…”

“…Generally in the lower limb, the Doppler probe is pointed up the limb towards the head of the patient (cephalad) and angled at approximately 45° [ 11 ]. Adequate water-based coupling gel should be used to conduct the signal [ 11 ]. Care should be taken with the amount of pressure applied, as too much pressure will obliterate the signal or lead to an artificially resistant looking waveform [ 10 ].…”

“…There is very little anatomical variation of the posterior tibial artery at the level of the medial malleolus, as it lies within the tarsal tunnel in 91% of the population [ 12 ]. The posterior tibial artery and dorsalis pedis artery are similarly small calibre arteries (between 1.96-2.05 mm) [ 13 ] which can make detection challenging, with further difficulties arising in larger limbs, the presence of oedema and excess adiposity [ 11 ].

Fig 3 Locations for pulse insonation, Left) from proximal to distal, the peroneal pulse, anterior tibial, dorsalis pedis pulse, and the distal dorsalis pedis pulse Right) posterior tibial pulse

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How sensitive and specific is continuous-wave Doppler for detecting peripheral arterial disease in people with and without diabetes? A cross-sectional study

“…4 CWD ultrasound is commonly used in conjunction with the ankle-brachial index (ABI) and is used to identify the presence and severity of peripheral arterial disease (PAD), and to monitor the progression of the disease. 4,5 There is growing evidence that the diagnostic accuracy of the ABI is limited in specific populations including those with diabetes. Variable sensitivity of the ABI for PAD has been reported in diabetes cohorts, 3,6 with multiple factors including the presence of medial arterial calcification (MAC); with increased likelihood of coexistent PAD 7 and distal anatomical distribution of atherosclerotic lesions, 8 likely to contribute to this.…”