Clinical Guidelines

Abnormal PSV Criteria

Vessel Type	Abnormal Velocity Criteria
Normal Vessel	> 125 cm/s
Within Stent	> 180 cm/s
Within Bypass	< 45 cm/s

References

[Mills et al. 1994] Mills, J.L., Gahatan, V., Bandyk, D.F., Esses, G.E. The origin of infrainguinal vein graft stenosis: a prospective study based on duplex surveillance. Journal of Vascular Surgery, 20:426–433.

[Bandyk 1993] Bandyk, D.F. Essentials of graft surveillance. Seminars in Vascular Surgery, 6:92–102.

[Caps et al. 1995] Caps, M.T., Cantwell-Gab, K., Bergelin, R.O., Strandness, D.E., Jr. Vein graft lesions: time of onset and rate of progression. Journal of Vascular Surgery, 22:466–474.

Abnormal Waveform Criteria

If the waveform is not multiphasic, it is classified as an abnormal waveform.

References

[Kim et al. 2020] Kim ES, Sharma AM, Scissons R, et al. Interpretation of peripheral arterial and venous Doppler waveforms: A consensus statement from the Society for Vascular Medicine and Society for Vascular Ultrasound. Vasc Med. 2020 Oct;25(5):484–506.doi:10.1177/1358863X20937665

Vessel Stenosis Criteria — PSV-Based

Stenosis Grade	PSV	PSV Ratio
Normal	< 125 cm/s	< 1.5
Mild (< 50%)	< 125 cm/s	1.5 – 2
Moderate (50–75%)	> 125 cm/s	2 – 4
Severe (> 75%)	> 400 cm/s	> 4
Occlusion	< 50 cm/s	—

References

[Strandness 2002] Strandness, D.E., Jr. Peripheral arterial system. Duplex Scanning in Vascular Disorders, 3rd ed. Chapter 7, pp. 118–143. Lippincott, Williams & Wilkins.

[Zaccardi & Olmsted 2002] Zaccardi, M.J. and Olmsted, K.A. Peripheral arterial evaluation. Duplex Scanning in Vascular Disorders, 3rd ed. Chapter 15, pp. 253–266. Lippincott, Williams & Wilkins.

Vessel Stenosis Criteria — Waveform-Based

Stenosis Location	Change in Waveform
Proximal Stenosis	Multiphasic → Monophasic
Distal Stenosis	Multiphasic → Monophasic Continuous

References

[Kim et al. 2020] Kim ES, Sharma AM, Scissons R, et al. Interpretation of peripheral arterial and venous Doppler waveforms: A consensus statement from the Society for Vascular Medicine and Society for Vascular Ultrasound. Vasc Med. 2020 Oct;25(5):484–506.doi:10.1177/1358863X20937665

Vessel Stenosis Criteria — Abnormal PSV with Waveform

Stenosis Grade	Waveform Character
Mild (< 50%)	Multiphasic
Moderate (50–75%)	Monophasic

References

[Kim et al. 2020] Kim ES, Sharma AM, Scissons R, et al. Interpretation of peripheral arterial and venous Doppler waveforms: A consensus statement from the Society for Vascular Medicine and Society for Vascular Ultrasound. Vasc Med. 2020 Oct;25(5):484–506.doi:10.1177/1358863X20937665

Within Stent Stenosis Criteria

Stenosis Grade	Velocity	Ratio
Mild (< 50%)	< 180 cm/s	< 3
Moderate (50–75%)	180 – 300 cm/s	< 3.5
Severe (> 75%)	> 300 cm/s	> 3.5

References

[Zheng et al. 2020] Zheng H, Calligaro KD, Jang J, et al. Duplex Ultrasound for Diagnosis of Failing Stents Placed for Lower Extremity Arterial Occlusive Disease. Ann Vasc Surg. 2020 Feb;63:269–274.doi:10.1016/j.avsg.2019.08.086

PAT Class Criteria

Plantar Acceleration Time (PAT) evaluates flow to the foot. Class 4 additionally requires velocity < 6 cm/s.

PAT Class	PAT Time	Velocity
Class 1	< 120 ms	—
Class 2	120 – 180 ms	—
Class 3	180 – 225 ms	—
Class 4	> 225 ms	< 6 cm/s

References

[Sommerset et al. 2019] Sommerset et al. Plantar Acceleration Time: A Novel Technique to Evaluate Flow to the Foot. Association for Vascular Surgery 2019.

Aortoiliac Disease

If the CFA (Common Femoral Artery) or PFA (Profunda Femoris Artery) has an abnormal waveform, there is a possibility of underlying aortoiliac disease.

References

[Kim et al. 2020] Kim ES, Sharma AM, Scissons R, et al. Interpretation of peripheral arterial and venous Doppler waveforms: A consensus statement from the Society for Vascular Medicine and Society for Vascular Ultrasound. Vasc Med. 2020 Oct;25(5):484–506.doi:10.1177/1358863X20937665