CASE STUDY OF DOPPLER ARTERIAL LEG

(Any of the images can be viewed by clicking on the image)

Clinical History
The following represents the Doppler ultrasound findings in a recently referrred patient to MSI-CAMBERWELL.

Patient Z is a 73 y.o. healthy and active female who presented to her clinician complaining of typical claudication with exertion (walking up hill or any distance of 200 metres or more). Patient Z was a non-smoker.

The clinician had scheduled the patient for a bilateral leg arterial Doppler examination to evaluate the extent (if any) of peripheral vascular disease(PVD) in either leg.

Doppler
The left leg was examined first as symptoms in this limb were where the patient had indicated to be the worst. Assessment was commenced at the groin to assess the femoral arterial flow.

The flow in the common femoral artery was  triphasic which was deemed to be normal (Figure 1)

A short progression down the thigh and the sampled spectral pattern from the femoral artery changed to a monophasic waveform and continued with ever-diminishing amplitude as the sample continued throughout the thigh (Figure 2 / Figure 3).

The waveform in the popliteal artery was by now damped  severely and at a level just below the knee crease the colour thrill of a stenosis could be seen.

Spectral assessment of the stenosis reveals a high velocity jet affecting the distal popliteal artery just as the anterior tibial artery branches off. It was also noted that the blood flow in the tibio-peroneal trunk on this patient was affected.

The spectral velocity at the stenosis contrast greatly with the severely damped flow that preceded the stenosis amplyfing the severity of the stenosis estimated at 80+ % (Figure 6/ Figure 7).

During the course of the examination it was also noted that the left foot was colder than the right at all times during the peformance of the examination on both legs. By contrast the right leg showed no sign of significant peripheral vascular disease.

Correlative angiography would be the next step for this patient along with referral to a vascular specialist.