Guidelines for the assessment of the arterial circulation of the lower limbs

In addition to the clinical assessment, the first test is Continuos wave Doppler (CWD) measuring the systolic pressure at the ankle and theankle-brachial pressure index (ABI).The ABI is important not only to assess the severity ofthe arterial disease, but also as a pathology marker, mainly for cardiovascular mortality in the elderly.1 The ABI is less reliable in diabetic patients owing to the calcifications and sequential stenoses. Some authors report a 70.6% sensitivity with an 88.5% specificity.Measurement of the segmentary pressures may be useful to suggest the site of the obstructive lesions.The pressure indexes can be determined after a treadmill test. The ColorDoppler sonography (CDS) is used for the morphological study of segments of the lower limb arteries. and it can sometimes replace angiography in deciding the treatment strategy,he ultrasound image with regard to angiography. However, it must still be verified if it is enough for treatment planning or if it is an economically sound proposal, considering that in any case it is necessary to resort to other X-ray studies in a certain number of cases.The CDS is still the examination of choice in follow-up and in monitoring the patient who has undergone invasivetreatment, whether surgical or endovascular. Specifically, the CDS is extremely reliable in testing patients carrying femoral-popliteal bypasses, both in vein andin prosthetic material, since it is able to assess the state ofthe anastomosis, of the graft, and of the inflow and outflowvessels, and to detect the stenoses that might lead to occlusion of the bypass.In those patients undergoing endovascular treatment, AngioCT is taking an increasingly important role as asecond level examination for patients with peripheral arterial disease. It is essentially associated with rapid technological development and the possibility to carry out acomplete study of the entire circulatory tree with subcentrimetric scans in just a few seconds. Actually, the agreement between AngioCT angiography is maximum in the iliac-femoral and above knee femoral-popliteal area, with a marked advantage for the AngioCT in the planimetric assessment of proximal lesions,whereas it drops significantly in assessing the below kneesand distal vessels.11 This is why the most recent guidelines 4 suggest using AngioCT in patients who are candidatesfor revascularization when AngioMR is contraindicated or unavailable.