Arterial Doppler Ultrasound is a type of sonography that used to show and estimate blood flow through blood vessels. Arterial Doppler Ultrasound can help diagnose peripheral vascular diseases: blood clots, poorly functioning valves, blocked arteries, and circulation problems.
Such as (but not limited):

• narrowing or widening of an artery
• superficial thrombophlebitis
• arteriosclerosis
• thromboangiitis obliterans
• vascular tumors in arms or legs
• cystic adventitial
• vasculitis

Indications for Arterial (Color) Doppler Ultrasonography  include but are not limited to:

• Having Peripheral arterial disease (PAD) symptoms***
• Claudication pains: painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising, buttocks pain, aching or burning feeling
• Numbness or weakness in arms and legs
• Soreness, tenderness, redness, swelling or warmth; Cold feeling in your lower part of leg or foot
• Pain that does not go away when you stop exercising, swelling
• Change in color and/or shiny skin; Poor nail growth on the toes or hair growth on the legs
• Nonpalpable distal pulses; auscultation of bruits over the iliac, femoral, or popliteal arteries; abnormal capillary refill time
• Erectile dysfunction, especially in men with diabetes
• Inflammatory conditions – swelling in your legs, feet, and/or abdomen
• Abnormalities established by the ankle-brachial index (ABI)
• Musculoskeletal disorders
• History of a blood vessels injury and surgery; Patients being treated for a blood flow disorder.
• Assess a vascular dialysis device (such as an A-V fistula in the arm)

In conjunction with factors of: older age, heart problems, smoking, diabetes mellitus, hypertension, hyperlipidemia, renal insufficiency (glomerular filtration rate less than 60 mL per minute per 1.73 m2), and non-Hispanic black race, a family history of premature CAD.

***Only 10% of patients with PAD have classic claudication; others have atypical leg pain (50%) or are asymptomatic (40%)

Transcranial Doppler (TCD) and Transcranial Color Doppler (TCCD) measure the velocity of blood flow through the brain’s blood vessels ( arteries known as the Circle of Willis) transcranial (through the cranium). The TCD with combined ColorFlow and Power Doppler allows direct imaging of the intracranial arteries, their anatomic course, diameter, and relationships with the adjacent structures. Effective for detecting sickle cell disease, ischemic cerebrovascular disease, subarachnoid hemorrhage, arteriovenous malformations, syncope, acute ischemic stroke and cerebral circulatory arrest.

The tests are possibly useful for perioperative monitoring and meningeal infection. TCD used as tests to help diagnose emboli, stenosis, vasospasm from a subarachnoid hemorrhage (bleeding from a ruptured aneurysm), and other problems.TCD has important clinical application in the management of patients with sickle-cell disease, brain stem death, and raised intracranial pressure (ICP). Moreover, TCD allows for intraoperative monitoring, evaluation of vasomotor function, and assessment of cerebral microembolism due to right to left cardiac shunts; monitoring of cerebral circulation and embolization during cardiopulmonary bypass, carotid endarterectomies, and carotid artery stenting.

Indications for TCD Sonography include but are not limited to:

• Ischemic cerebrovascular disease
• Numbness or weakness of the face, arm or leg, especially on one side of the body
• Confusion, trouble speaking or understanding; Trouble seeing in one or both eyes
• Trouble walking, dizziness, loss of balance or coordination
• Severe headache with no known cause subarachnoid hemorrhage, double vision, sensitivity to light, or vision loss with or without nausea or vomiting
• Also common: severe headache, abnormal heart rhythm, altered level of consciousness, coma, fainting, seizures, stiff neck, or weakness of one side of the body
• Ischemic stroke
• Vision problems, such as blindness in one eye or double vision weakness or paralysis in your limbs, which may be on one or both sides, depending on the affected artery dizziness and vertigo, confusion, loss of coordination, drooping of face on one side
• Symptoms of embolism

Aorta Doppler Ultrasonography is the first-line imaging study for the diagnosis and the postoperative evaluation and follow-up of patients with diseases of the abdominal great vessels. Color Doppler Sonography provides comprehensive and functional data, which were often unattainable with other methods. Aorta Doppler Ultrasonography is the major diagnostic procedure for the aorta – the largest artery in the body and accordingly, the number 1 diagnostic for Abdominal Aortic aneurysm (AAA).The majority of AAAs are the result of atherosclerosis, which is characterized by the formation of atheromas atheromata, which are raised, fibroadipose plaques that develop within the intimal layer of the artery or within the innermost layers of the tunica media. Apart from arterial thrombosis, embolism, and vasculitis, acute ischemia can also be caused by the simultaneous development of portal hypertension or thrombosis of the superior mesenteric vein.

Abdominal Aortic Aneurysms typically develop slowly over a period of many years and hardly ever cause any noticeable symptoms. Some aneurysms never rupture. Many start small and stay small; others expand over time, some quickly. Occasionally, especially in thin patients, a pulsating sensation in the abdomen may be felt. Acute Mesenteric Ischemia is associated with high mortality rate. The larger an aneurysm grows, the greater the chance it will burst, or rupture, though diagnostics play crucial role in patient well-being.

Indications for Aorta Doppler Ultrasonography include but are not limited to:

• Unexplained lower back pain, flank pain, chest, abdominal area. In some cases in groin, buttocks, or legs. The pain may be deep, aching, gnawing, or throbbing, and it may last for hours or days. Generally it is not affected by movement. Certain positions may be more comfortable than others.
• Palpable or pulsatile abdominal mass or abdominal bruit.
• A “cold foot” or a black or blue painful toe due arterial emboli
• Fever or weight loss caused to inflammatory aortic aneurysm.The symptoms that are similar to the symptoms of coronary artery disease, gastroesophageal reflux disease (GERD), and peptic ulcer disease.
• Follow-up of a previously demonstrated AAA.

Abdominal Aortic Aneurysm risk factors include: Tobacco use, age 65 and older, being male, white race, family history, having an aneurysm in another large blood vessel.

*Aortic aneurysm burst or rupture, without immediate treatment, can quickly lead to death.

Carotid Doppler Ultrasonography is a powerful modality for evaluating the carotid arteries, (ICA and ECA) – shows the structure and blood movement. Carotid Doppler Ultrasonography is useful not only for detecting carotid artery stenosis but also for detecting atherosclerotic plaque including visualizing the intima media thickness as a biomarker for atherosclerosis.

Carotid Artery Disease (CAD) develops slowly and in many cases, even with a severe blockage, patients experience no symptoms. CAD is a major cause of stroke in the United States. The first sign of the condition may be a stroke or transient ischemic attack (TIA).

There are 2 main groups that should be directed for Carotid Doppler Ultrasonography: symptomatic group (which is consist of patients with neurologic incidents such as, patients with the transient ischemic attack, amaurosis fugax, and a minor stroke) and asymptomatic group (which contains patients with cervical bruit, endarterectomy, and neck mass)

Carotid Artery Doppler Sonography should be fully recommended for examination before a major cardiovascular operation, especially coronary artery surgery.

Indications for CCA Doppler Ultrasonography include but are not limited to:

• Bruit Mini-strokes and all transient ischemic attack symptoms (TIA), history of TIA.
• Strokes
• Temporary loss of vision in one eye
• Carotid artery narrowing, known as stenosis

Additional factors:

• Smoking
• High levels of certain fats and cholesterol in the blood
• High blood pressure
• High levels of sugar in the blood due to insulin resistance or diabetes
• A family history of stroke or heart disease
• Tinnitus,
• Increased Heart Rate, Headaches, Blurred Vision, Light-headedness, Poor Balance, Weakness, Loss of Coordination, Lack of exercise, Sleep apnea

Venous Doppler Ultrasonography is the first choice and often the gold standard imaging technique for the diagnosis of Acute and Chronic Venous diseases. Venous diseases are highly prevalent, mostly caused by valve incompetence and/or obstruction of the vein lumen but signs and symptoms are diverse and unspecific.

Deep venous thrombosis (DVT) is a common disease with potentially serious consequences such as pulmonary embolism (PE). Three factors, namely, blood flow, hypercoagulability, and endothelial injury play and important role in the process of thrombus formation, and they are referred to as Virchow’s Triad

Many of patients referred for Venous Doppler Ultrasonography present with primary superficial varicose veins. Less commonly, lower extremity venous disease is complicated by previous thrombotic events (deep or superficial) resulting in a range of problems in various venous segments including: occlusive or non‐occlusive chronic thrombotic residua, venous wall fibrosis and incompetence of the affected segments. Another distinct group of patients are those representing with recurrent varicose veins following past interventions.

The majority of vessel injuries affect the upper and lower limbs. Vessel injury is a serious problem for physicians, as some vascular lesions may not be initially recognized based on clinical evaluation and vital signs. Thus, Color Doppler Sonography – Venous Duplex Ultrasound (VDUS) is currently considered as the first-line examination for evaluation of vascular injuries, and should be the basis for diagnosis and care.

Venous Doppler Ultrasonography is also used for obtaining venous access, guiding venous procedures, determiningthe immediate outcome of treatment, and short-term and long-term follow-up of patients.

Indications for Venous Doppler Ultrasonography include but are not limited to:

• Suspected upper-extremity deep vein thrombosis / Acute venous thrombosis
• Chronic venous insufficiency
• Chronic venous obstruction-Failure of vein to collapse on direct compression / visualisation of thrombus within lumen / absent or abnormal venous pulsation
• Homan’s signs
• Edema, pain and redness in the legs, tenderness over the calf
• Suspected or healed venous ulcer
• Spider veins (telangiectasias)
• Varicose veins with lower extremity pain or heaviness / Varicose veins with chronic lower extremity swelling or skin changes of chronic venous insufficiency (e.g., hyperpigmentation or lipodermatosclerosis)
• Skin changes of chronic venous insufficiency without visible varicose veins (e.g., hyperpigmentation or lipodermatosclerosis)
• Limb swelling: unilateral (acute) – suspected acute venous thrombosis

Venous Doppler Ultrasonography is use to:

• Evaluation of possible venous thromboembolic disease or venous obstruction in symptomatic or high-risk asymptomatic individuals.
• Assessment of dialysis access
• Assessing competence of valves in deep veins
• Assessment of venous insufficiency, reflux, and varicosities
• Preoperative mapping of saphenous vein / Evaluation of veins prior to venous access,
• After orthopedic surgery

Additional factors: surgery or injury, long-term bed rest or immobility, pregnancy, obesity, a history of venous thrombosis