Standardized duplex ultrasound protocols and criteria

in Vascular Diagnostics and Imaging

Applied

Type

Modification

Confidence

90%

Created

Mar 19, 2026

Evidence

2 sources

Rationale

The section was updated to incorporate the 2024 ACC/AHA PAD guidelines, which provide the most current standards for DUS in PAD diagnosis and surveillance. A 2025 scoping review was also integrated to address the importance of standardized reporting in carotid ultrasound. Abbreviations were expanded on first use (DUS, ICA, CCA, PAD) as per the instructions.

Evidence

Gornik HL, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease. Circulation. 2024. PMID: 38743805.
Verified source
PubMedDOI
Mukabagorora T, et al. A comprehensive scoping review of existing carotid duplex ultrasound scanning and reporting protocols: identifying gaps and opportunities for standardization of practice in low-income countries. J Ultrasound. 2025. PMID: 40866737.
Verified source
PubMedDOI

Content Changes

**Standardized Duplex Ultrasound Protocols and Criteria**

Standardized protocols and interpretation criteria are essential for reliable duplex ultrasound (DUS) assessment:

* **Carotid artery stenosis:** Stenosis severity is graded using peak systolic velocity (PSV) and internal carotid artery/commonartery (ICA)/common carotid artery (ICA/CCA)(CCA) ratio. Laboratory-validated thresholds should be used, typically PSV ≥125 cm/s for ≥50% stenosis and ≥230 cm/s for ≥70% stenosis according to consensus criteria. Reports should include plaque morphology and contralateral disease status.status, though significant global variation in reporting protocols highlights the need for further standardization [@mukabagorora2025].
* **Lower extremity arterialperipheral disease:**artery disease (PAD):** Assessment includes PSV, velocity ratios (VR) across lesions, and waveform analysis. DUS is recommended as a primary diagnostic tool for the anatomical localization of stenosis and to guide revascularization strategies [@svs2024-f]. Velocity ratio thresholds help identify hemodynamically significant stenoses, with documentation of inflow, outflow, and runoff status.
* **Post-intervention surveillance:** Graft surveillance employs specific thresholds, with high PSV and velocity ratios indicating stenosis and low graft PSV suggesting risk of thrombotic failure. The 2024 multi-society guidelines emphasize the role of DUS in the surveillance of autogenous vein bypass grafts and following endovascular interventions [@svs2024-f]. Endovascular aneurysm repair (EVAR) surveillance protocols integrate duplex findings with cross-sectional imaging.

These protocols align with ESVS carotid guidelines andguidelines, Society of Radiologists in Ultrasound (SRU) consensus statements.statements, and the 2024 ACC/AHA PAD guidelines. [@sru2003] [@esvs2018-esvs] [@moneta2010] [@svs2024-f]
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