Patterns of Infra-Popliteal Arterial Disease

Introduction The growth of the diabetic population and the increased prevalence of peripheral arterial disease (PAD) below the knee has created an increased demand for duplex ultrasound (DUS) evaluation of the infra-popliteal arteries. The purpose of this study is to show how DUS can be used to identify the patterns of infra-popliteal arterial occlusive disease. Methods: We performed infra-popliteal duplex ultrasound scans on 100 consecutive patients (199 limbs) with suspected PAD. Peak systolic velocity (PSV) was obtained from the anterior tibial artery (ATA) and posterior tibial artery (PTA) at the distal, mid, and proximal calf levels. The acceleration time (AT) was measured in the distal ATA and PTA segments. Results: The PTA was the infra-popliteal artery that was most often totally occluded (21% of limbs). Segmental PTA occlusions occurred predominantly in the proximal and distal segments. The ATA was totally occluded in 8% of limbs, with segmental occlusions located predominantly in the mid segment. We also confirmed that proximal PAD prolongs distal infra-popliteal artery AT and reduces distal PSV. Conclusion: These data add to our understanding of the patterns of infra-popliteal arterial disease and should be of interest to sonographers who perform DUS of the lower extremity arteries.