Doppler sonographic examination of reactive hyperemia in the diagnosis of peripheral vascular disease

Summary

Fifty-four patients with angiographically confirmed peripheral vascular disease (PVD) were examined in order to find out whether the occlusive form of this disease can be better diagnosed by measuring the reappearance time and mean velocity of the blood flow during reactive hyperemia than by determining the peripheral systolic blood pressure, using Doppler ultrasound for both measurements. It was shown that the Doppler pressure was only reliable for a screening diagnosis of PVD. However, using the reappearance time of reactive hyperemia, it was possible to distinguish specific localization types of sclerosis; while reactive hyperemia already reached its half maximum in controls in 4.6 s this occurred in the stenosis type of PVD after 6.9 s, in the upper leg occlusion type after 21.6 s, in the lower leg occlusion type after 46.6 s, and in the multilevel disease after 70.1 s. The delay in the half-maximum reappearance time was significantly different, not only in comparison with controls (P<0.001) but also in the specific types of occlusive PVD as compared with one another (P<0.01). Regarding the intensity of velocity it could also be shown that the mean velocity of blood flow during reactive hyperemia was lower in all patients with PVD than in controls. Again this alteration during reactive hyperemia was significant, not only in comparison with controls (P<0.001), but also when the specific stages of severity according to Fontaine were compared with one another (P<0.05). On the basis of these findings it can be stated that in addition to providing a screening diagnosis of PVD on the basis of the Doppler pressure, the Doppler ultrasound measurement of reactive hyperemia is useful for a specific diagnosis of the localization and severity of PVD.