Measure the Vascular Flow Volume rather than Vascular Stenosis and Pressure Gradient Tugce Ozlem Kalayci, MD a* , Volkan C ¸ akir a , Mert Kestelli b , Melda Apaydin a a Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey b Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, I ˙ zmir, Turkey Received 15 June 2014; received in revised form 22 December 2014; accepted 23 December 2014; online published-ahead-of-print 28 January 2015 Introduction Peripheral arterial disease (PAD) is characterised by flow- limiting stenosis or occlusion in the vessels supplying the lower limbs [1]. A non-invasive technique capable of mea- suring tissue perfusion would be of great clinical value for assessing the severity of the disease and monitoring the response to therapeutic interventions [2]. We assessed the extent to which measurement of flow volume (FV) with colour flow duplex ultrasonography (CDU) can be used to predict tissue perfusion in a patient with PAD. We then compared these results with those found using lower extrem- ity digital subtraction angiography (DSA). Case Report A 68 year-old male patient was admitted to our clinic com- plaining of intermittent claudication in the right leg. The ankle brachial pressure index of his right leg was 0.6. DSA was performed for the lower extremity arterial system. CDU was then performed with an Aplio XG (Toshiba Corporation, Japan) using a 7–12 MHz linear array transducer. Analysis of the flow was carried out after 10 min of rest to allow the muscles to reach a resting state. Arterial and venous CDU was obtained in the supine position with the foot elevated 15 cm to neutralise the central venous pressure. The vessel diameter, blood flow velocity and FV in the arteries and veins of the lower extremities were calculated without compres- sion. The common femoral artery (CFA) and popliteal artery (PA) were examined 1 cm above the bifurcation, and the common femoral vein (CFV) and popliteal vein (PV) were examined 1 cm above the saphenofemoral and saphenopo- pliteal junction. The anterior tibial artery (ATA), posterior tibial artery (PTA), anterior tibial vein (ATV), and posterior tibial vein (PTV) were examined 2 cm proximal to the ankle. DSA illustrated total occlusion of the right femoral artery (FA). The right PA was filling by collateral vessels from the We aimed to investigate the extent to which measurements of flow volume (FV) with colour flow duplex ultrasonography (CDU) could predict tissue perfusion. A 68 year-old male patient was admitted to our clinic complaining of intermittent claudication in the right leg. Digital subtraction angiography showed total occlusion of the right femoral artery. The right popliteal artery (PA) was filling by collaterals. CDU showed that the FV in the right PA was higher than in the left. Arterial-venous FV measurement with CDU should be performed rather than the detection of arterial stenosis to assess whether intervention is necessary. Keywords Peripheral arterial disease  Colour flow duplex ultrasonography  Lower extremities  Angiography  Ischaemia © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved. *Corresponding author at: Gazeteci Hasan Tahsin Caddesi, Izmir Katip Celebi Universitesi, Ataturk Training and Research Hospital, Department of Radiology, Karabaglar, Izmir, Turkey. Postal code: 35160 Tel.: +90 232 245 4545; fax: +90 232 243 3208 Tel.:+90 530 227 0218., Email: doktorozlemtugce@gmail.com Heart, Lung and Circulation (2015) 24, 617–620 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.12.164 BRIEF COMMUNICATION