Doppler ultrasound diastolic flow analysis for the early identification of peripheral arterial disease.
OBJECTIVE
The viscoelastic mechanical compliance properties of the human arterial system were examined in 100 subjects with A-mode Doppler ultrasound diastolic flow analysis. This technique of diastolic flow analysis is utilized to identify early atherogenic peripheral arterial disease. The sensitivity of the commonly utilized standard traditional ultrasound pressure-grade pneumatic cuff examination will be increased when accompanied by the diastolic flow analysis technique.


METHODS
Diastolic flow analysis will aid in the early identification of lower extremity vascular claudication when lumbar spinal canal stenosis and elevated cardiovascular risk factors are present. This examination may be performed in the office setting with standard A-mode Doppler ultrasound equipment along with the usual pneumatic cuff procedure. The standard ultrasound cuff examinations are based on pressure gradients to identify lower extremity arterial disease. The low level of sensitivity of this test requires arterial obstruction of at least 50% to be present before positive identification is possible. Pathological alterations of the arterial wall occur during the early stages of atherosclerotic disease, are reflected by reduced wall distensibility and may be quantified by Doppler ultrasound.


METHODS
Studied were a total of 100 subjects, 50 with arterial disease risk factors and 50 normal controls. All subjects were screened for aortic coarctation, myocardial infarction, tachyarrhythmia, aortic value stenosis and mitral prolapse. The risk group subjects were all smokers and had a mixed distribution of hypertension, hypercholesterolemia and hyperglycemia. The commonly utilized standard traditional ultrasound pneumatic cuff examination was negative in all subjects. Anthropometric measurements and percent body fat were also obtained. Arterial diastolic antegrade flow analysis was performed with Doppler ultrasound on each subject.


RESULTS
This study demonstrated that the elevated vascular risk factor group had a mean arterial distensibility measurement of 4.4 +/- 5.0%, and the control group displayed a mean measurement of 20.0 +/- 6.0%. The 50 elevated risk factor subjects showed approximately 5 times greater arterial stiffness and were identified with significance at an F test level of (p less than .001).


CONCLUSIONS
This arterial compliance evaluation procedure is shown to be a reliable sensitive indicator of early atherosclerotic disease prior to the development of obstructive arterial lesions.
Terenzi
T J
TJ
Teachers College, Columbia University, New York, NY 10027.
Beadle
E
E
Muller
D
D
DeMeersman
R
R
D000273:Adipose Tissue; D000328:Adult; D000368:Aged; D000886:Anthropometry; D001011:Aorta / Q000000981:diagnostic imaging; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001158:Arteries / Q000000981:diagnostic imaging; D001161:Arteriosclerosis / Q000000981:diagnostic imaging*; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014463:Ultrasonography