Interpretation of Peripheral Arterial and Venous Doppler Waveforms: A Consensus Statement From the Society for Vascular Medicine and Society for Vascular Ultrasound

Abstract

This expert consensus statement on the interpretation of peripheral arterial and venous spectral Doppler waveforms was jointly commissioned by the Society for Vascular Medicine (SVM) and the Society for Vascular Ultrasound (SVU). The consensus statement proposes a standardized nomenclature for arterial and venous spectral Doppler waveforms using a framework of key major descriptors and additional modifier terms. These key major descriptors and additional modifier terms are presented alongside representative Doppler waveforms, and nomenclature tables provide context by listing previous alternate terms to be replaced by the new major descriptors and modifiers. Finally, the document reviews Doppler waveform alterations with physiologic changes and disease states, provides optimization techniques for waveform acquisition and display, and provides practical guidance for incorporating the proposed nomenclature into the final interpretation report.

Use of a Pre-Trained Neural Network for Automatic Classification of Arterial Doppler Flow Waveforms: A Proof of Concept

“…Although this agreement does not reach that obtained between two trained vascular physicians (Kappa = 0.83 (0.79–0.87), strong agreement) it is very similar and without any potential reproducibility error. These results are in keeping with those of previous studies where neural networks were used to diagnose PAD [ 23 , 24 ] and the prospect of perfect reproducibility is of importance, especially as an arterial Doppler waveform description is frequently debated amongst vascular medicine physicians [ 17 ]. Neural networks could indeed provide an objective approach for categorization and a description of arterial Doppler waveforms.…”

“…For years, researchers have described the relationship between waveform contours and PAD severity [ 10 , 11 , 12 , 13 ]. Arterial Doppler waveforms are usually described according to the number of phases (i.e., alternance between forward and backward flow) and “sharpness” (i.e., acceleration/deceleration of blood flow) [ 14 , 15 , 16 , 17 ]. It is commonly accepted that the greater the number of phases and the sharper the signal the healthier the artery, and vice versa [ 17 , 18 ].…”

“…Arterial Doppler waveforms are usually described according to the number of phases (i.e., alternance between forward and backward flow) and “sharpness” (i.e., acceleration/deceleration of blood flow) [ 14 , 15 , 16 , 17 ]. It is commonly accepted that the greater the number of phases and the sharper the signal the healthier the artery, and vice versa [ 17 , 18 ]. However, the interpretation and description of Doppler waveforms is highly subjective [ 19 ].…”

Pre-procedural color duplex ultrasound evaluation predicts restenosis after long-segment superficial femoral artery stenting

“…Although ultrasound images have acoustic shadows below calcified plaques, accurate assessment of flow velocity can use spectral analysis at the stenosis as well as in the proximal and distal segments. 24 In addition, CTA requires iodinated contrast and ionizing radiation, limiting its use in patients with renal dysfunction; however, ultrasound examination is rapid and safe, making it a better choice especially for patients with chronic renal failure.…”

Presidential Address: Perseverance through the pandemic and beyond

“…Drs Esther Kim and Aditya Sharma and other SVM members lead the SVM efforts for the SVM/SVU consensus statement on waveform nomenclature. 6 Drs Geoff Barnes, Ido Weinberg, and Rob Eberhardt represented SVM in collaboration with the Society of Interventional Radiology (SIR) to develop the clinical practice guideline for inferior vena cava filters in the treatment of patients with venous thromboembolic disease. 7 Drs Mark Creager and Naomi Hamburg led the 2020 ACC/AHA/SVM/ACP statement on advanced training on vascular medicine (in press for Fall 2020).…”