ABSTRACT
Diagnostic testing of patients with vascular disease requires a thorough understanding of the instrumentation, arterial and venous anatomy, and hemodynamics of blood circulation. Although physical examination and vascular imaging studies-such as contrast arteriography, magnetic resonance angiography, and contrast-enhanced computed tomography-are indispensable in the management of peripheral vascular disease, noninvasive vascular testing retains a prominent role in patient evaluation both prior to and following intervention. Methods that use Doppler ultrasound-in particular duplex ultrasonography-and plethysmography form the cornerstone of noninvasive vascular testing. Testing is used to detect and grade the severity of cerebrovascular, peripheral arterial, and peripheral venous disease and thereby assists in disease management. The accuracy of duplex ultrasonography coupled with indirect physiological testing methods is superior to clinical evaluation alone and in many patients provides sufficient anatomical information of disease extent and severity to proceed with surgical or endovascular intervention without confirmatory imaging studies. Newer enhancements of duplex ultrasonography-such as power Doppler angiography, sonographic composite imaging, and the use of contrast agents-have further improved anatomic resolution, which allows better characterization of the extent and morphology of vascular disease.
