Peripheral vascular disease assessment in the lower limb: a review of current and emerging non-invasive diagnostic methods

BackgroundWorldwide, at least 200 million people are affected by peripheral vascular diseases (PVDs), including peripheral arterial disease (PAD), chronic venous insufficiency (CVI) and deep vein thrombosis (DVT). The high prevalence and serious consequences of PVDs have led to the development of several diagnostic tools and clinical guidelines to assist timely diagnosis and patient management. Given the increasing number of diagnostic methods available, a comprehensive review of available technologies is timely in order to understand their limitations and direct future development effort.Main bodyThis paper reviews the available diagnostic methods for PAD, CVI, and DVT with a focus on non-invasive modalities. Each method is critically evaluated in terms of sensitivity, specificity, accuracy, ease of use, procedure time duration, and training requirements where applicable.ConclusionThis review emphasizes the limitations of existing methods, highlighting a latent need for the development of new non-invasive, efficient diagnostic methods. Some newly emerging technologies are identified, in particular wearable sensors, which demonstrate considerable potential to address the need for simple, cost-effective, accurate and timely diagnosis of PVDs.

[1]  Aditya M. Sharma,et al.  Duplex Ultrasound in the Diagnosis of Lower-Extremity Deep Venous Thrombosis , 2014, Circulation.

[2]  P. McCollum,et al.  Assessment of arterial disease using digital systolic pressure measurement. , 1988, Annals of vascular surgery.

[3]  R. J. Whitney,et al.  The measurement of volume changes in human limbs , 1953, The Journal of physiology.

[4]  P. Boutouyrie,et al.  Assessment of pulse wave velocity , 2008 .

[5]  D. Healy,et al.  Validation of air plethysmography, photoplethysmography, and duplex ultrasonography in the evaluation of severe venous stasis. , 1994, Journal of vascular surgery.

[6]  A. Meta-analysis Ankle Brachial Index Combined With Framingham Risk Score to Predict Cardiovascular Events and Mortality , 2010 .

[7]  L. Fleisher,et al.  2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , 2017, Journal of the American College of Cardiology.

[8]  D. Mukherjee,et al.  Peripheral arterial disease: Epidemiology, natural history, diagnosis and treatment , 2007, The International journal of angiology : official publication of the International College of Angiology, Inc.

[9]  Alexander M Seifalian,et al.  Optical techniques in the assessment of peripheral arterial disease. , 2007, Current vascular pharmacology.

[10]  M. O’Connell,et al.  Detection of clinically suspected deep vein thrombosis using light reflection rheography. , 1991, American journal of surgery.

[11]  M. Catalano,et al.  Reply to Arterial Stiffness in Patients With Peripheral Arterial Disease , 2013, Journal of clinical hypertension.

[12]  V Wienert,et al.  [Chronic venous insufficiency]. , 1996, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[13]  J. V. D. Stricht,et al.  [The importance of chronic venous insufficiency. Various preliminary data on its medico-social consequences]. , 1992, Phlebologie.

[14]  B. Eliasson,et al.  Assessment of Toe Blood Pressure Is an Effective Screening Method to Identify Diabetes Patients with Lower Extremity Arterial Disease , 2004, Angiology.

[15]  P. Holstein The distal blood pressure predicts healing of amputations on the feet. , 1984, Acta orthopaedica Scandinavica.

[16]  G. Den Ottolander,et al.  Home-Diagnosis of Deep Venous Thrombosis with Impedance Plethysmography , 1982, Thrombosis and Haemostasis.

[17]  D. Hu,et al.  Sensitivity and specificity of ankle-brachial index for detecting angiographic stenosis of peripheral arteries. , 2008, Circulation journal : official journal of the Japanese Circulation Society.

[18]  Luis M Lovato,et al.  Compression ultrasonography of the lower extremity with portable vascular ultrasonography can accurately detect deep venous thrombosis in the emergency department. , 2010, Annals of emergency medicine.

[19]  N. Labropoulos,et al.  Diagnosis of venous disease with duplex ultrasound , 2013, Phlebology.

[20]  Rodney A. White,et al.  ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Ang , 2006, Journal of the American College of Cardiology.

[21]  Tetsuo Shoji,et al.  Pulse wave velocity in lower-limb arteries among diabetic patients with peripheral arterial disease. , 2003, Journal of atherosclerosis and thrombosis.

[22]  Dong Yeon Lee,et al.  Photoplethysmography and Continuous-Wave Doppler Ultrasound as a Complementary Test to Ankle–Brachial Index in Detection of Stenotic Peripheral Arterial Disease , 2013, Angiology.

[23]  L. Groop,et al.  Development of new peripheral arterial occlusive disease in patients with type 2 diabetes during a mean follow-up of 11 years. , 2003, Diabetes care.

[24]  P. Wells,et al.  The diagnosis and treatment of venous thromboembolism. , 2013, Hematology. American Society of Hematology. Education Program.

[25]  Mandeep Singh,et al.  Introduction to Biomedical Instrumentation , 2010 .

[26]  K. Harding,et al.  The influence of diabetes and lower limb arterial disease on cutaneous foot perfusion. , 2006, Journal of vascular surgery.

[27]  Stanley S. Miller,et al.  The ultrasonic detection of incompetent perforating veins , 1974, The British journal of surgery.

[28]  E. Larsson,et al.  Peripheral arterial disease. , 2003, Clinical evidence.

[29]  P T Toy,et al.  Occlusive impedance plethysmography. A noninvasive method of diagnosis of proximal deep vein thrombosis. , 1978, The Western journal of medicine.

[30]  J. Dolan,et al.  Pulse oximetry as a potential screening tool for lower extremity arterial disease in asymptomatic patients with diabetes mellitus. , 2005, Archives of internal medicine.

[31]  M. Cushman Epidemiology and risk factors for venous thrombosis. , 2007, Seminars in hematology.

[32]  H. Parving,et al.  NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis , 2011, Cardiovascular diabetology.

[33]  L. Fleisher,et al.  2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary , 2016, Circulation.

[34]  J. Scurr,et al.  Photoplethysmography: a valuable noninvasive tool in the assessment of venous dysfunction? , 1992, Journal of vascular surgery.

[35]  Donald L. Miller,et al.  Multi-society consensus quality improvement guidelines for the treatment of lower-extremity superficial venous insufficiency with endovenous thermal ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology and , 2010, Journal of vascular and interventional radiology : JVIR.

[36]  C. L. Cutajar,et al.  Value of Cuff Occlusion Pressures in Assessment of Peripheral Vascular Disease , 1973, British medical journal.

[37]  T. Rooke,et al.  Exercise Strain-Gauge Venous Plethysmography: Evaluation of a "New" Device for Assessing Lower Limb Venous Incompetence , 1992, Angiology.

[38]  Matthew E. Anderson,et al.  Imaging evaluation of lower extremity infrainguinal disease: role of the noninvasive vascular laboratory, computed tomography angiography, and magnetic resonance angiography. , 2010, Techniques in vascular and interventional radiology.

[39]  A. Seagar,et al.  Automated venous occlusion plethysmograph , 1988, Medical and Biological Engineering and Computing.

[40]  D. Manning,et al.  Miscuffing: inappropriate blood pressure cuff application. , 1983, Circulation.

[41]  J. Zamorano,et al.  Enfermedad arterial periférica: eficacia del método oscilométrico , 2011 .

[42]  L. Lind,et al.  Ankle brachial index <0.9 underestimates the prevalence of peripheral artery occlusive disease assessed with whole-body magnetic resonance angiography in the elderly , 2008, Acta radiologica.

[43]  J D Richardson,et al.  Effect of multilevel sequential stenosis on lower extremity arterial duplex scanning. , 1995, American journal of surgery.

[44]  E. Barrett-Connor,et al.  Peripheral arterial disease in large vessels is epidemiologically distinct from small vessel disease. An analysis of risk factors. , 1989, American journal of epidemiology.

[45]  Yuan-Ting Zhang,et al.  Challenges and Opportunities in Cardiovascular Health Informatics , 2013, IEEE Transactions on Biomedical Engineering.

[46]  Thomas A. Mustoe, MD, FACS,et al.  Pharmacologic enhancement of wound healing. , 1995, Annual review of medicine.

[47]  A. Comerota,et al.  A noninvasive screening test to detect "critical" deep venous reflux. , 1995, Journal of vascular surgery.

[48]  A. Rosales,et al.  Stenting for chronic post-thrombotic vena cava and iliofemoral venous occlusions: mid-term patency and clinical outcome. , 2010, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[49]  R. Gusberg,et al.  Light reflection rheography: a simple noninvasive screening test for deep vein thrombosis. , 1993, Journal of vascular surgery.

[50]  W. Lamorte,et al.  Risk factors for chronic venous insufficiency: a dual case-control study. , 1995, Journal of vascular surgery.

[51]  F. Fowkes,et al.  Assessment of peripheral vascular disease in diabetics. , 1994, Circulation.

[52]  Qingmao Hu,et al.  Computational evaluation of smoothed particle hydrodynamics for implementing blood flow modelling through CT reconstructed arteries. , 2017, Journal of X-ray science and technology.

[53]  J. Bergan,et al.  VASCULAR-LABORATORY DIAGNOSIS OF CLINICALLY SUSPECTED ACUTE DEEP-VEIN THROMBOSIS , 1978, The Lancet.

[54]  R. Langer,et al.  Mortality over a period of 10 years in patients with peripheral arterial disease. , 1992, The New England journal of medicine.

[55]  T. Winsor INFLUENCE OF ARTERIAL DISEASE ON THE SYSTOLIC BLOOD PRESSURE GRADIENTS OF THE EXTREMITY , 1950, The American journal of the medical sciences.

[56]  Kelvin K. L. Wong,et al.  Ethical principles and standards for the conduct of biomedical research and publication , 2015, Australasian Physical & Engineering Sciences in Medicine.

[57]  A. Sawka,et al.  Effect of Temperature on Digital Systolic Pressures in Lower Limb in Arterial Disease , 1992, Circulation.

[58]  Kelvin K. L. Wong,et al.  Ethics policies and procedures in imaging and interventional radiology , 2015, Australasian Physical & Engineering Sciences in Medicine.

[59]  C. Choi,et al.  Utility of Toe-brachial Index for Diagnosis of Peripheral Artery Disease , 2012, Archives of plastic surgery.

[60]  L. Ferrucci,et al.  Associations of borderline and low normal ankle-brachial index values with functional decline at 5-year follow-up: the WALCS (Walking and Leg Circulation Study). , 2009, Journal of the American College of Cardiology.

[61]  J. Benenati,et al.  Noninvasive Testing in Peripheral Arterial Disease. , 2014, Interventional cardiology clinics.

[62]  B. Thompson,et al.  Colour duplex ultrasound: a screening modality for femoropopliteal disease in patients with intermittent claudication. , 1994, Australasian radiology.

[63]  M. Catalano,et al.  Increased Aortic Stiffness and Related Factors in Patients With Peripheral Arterial Disease , 2013, Journal of clinical hypertension.

[64]  D. Sackett,et al.  Combined use of leg scanning and impedance plethysmography in suspected venous thrombosis. An alternative to venography. , 1977, The New England journal of medicine.

[65]  M. Elgendi On the Analysis of Fingertip Photoplethysmogram Signals , 2012, Current cardiology reviews.

[66]  W M O'Fallon,et al.  Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. , 1998, Archives of internal medicine.

[67]  J. Bergan,et al.  INTRODUCTION TO VASCULAR ULTRASONOGRAPHY , 1987 .

[68]  Lin Xu,et al.  Influence of beat-to-beat blood pressure variability on vascular elasticity in hypertensive population , 2017, Scientific Reports.

[69]  E. Maltezos,et al.  Peripheral Arterial Occlusive Disease as a Predictor of the Extent of Coronary Atherosclerosis in Patients with Coronary Artery Disease with and without Diabetes Mellitus , 2004, The Journal of international medical research.

[70]  A. M. Kupinski Segmental Pressure Measurement and Plethysmography , 2002 .

[71]  E F Bernstein,et al.  Noninvasive physiologic tests in the diagnosis and characterization of peripheral arterial occlusive disease. , 1973, American journal of surgery.

[72]  Chung-Ming Chen,et al.  Computer-Aided Detection and Diagnosis in Medical Imaging , 2013, Comput. Math. Methods Medicine.

[73]  L. Norgren,et al.  Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). , 2007, Journal of vascular surgery.

[74]  J. Sc PHENOTHIAZINE PIGMENTATION AND VISCERAL INFILTRATION. , 1965 .

[75]  N. Keiding,et al.  Strain-gauge versus water plethysmography description of simplified systems and analysis of differences and accuracy , 1974, Medical and biological engineering.

[76]  H. K. Kim,et al.  Detection of Peripheral Arterial Disease Within the Foot Using Vascular Optical Tomographic Imaging: A Clinical Pilot Study. , 2015, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[77]  J. Skinner,et al.  Prediction of claudication pain from clinical measurements obtained at rest. , 1992, Medicine and science in sports and exercise.

[78]  H. Büller,et al.  Detection of deep vein thrombosis with impedance plethysmography and real-time compression ultrasonography in hospitalized patients. , 1992, Archives of internal medicine.

[79]  Heather L. Gornik,et al.  Peripheral arterial disease. , 2005, Major problems in clinical surgery.

[80]  Gaetano D. Gargiulo,et al.  Hemodynamic monitor for rapid, cost-effective assessment of peripheral vascular function , 2014, 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[81]  Yang Liu,et al.  Sensitive, high-strain, high-rate bodily motion sensors based on graphene-rubber composites. , 2014, ACS nano.

[82]  J. Zamorano,et al.  [Peripheral arterial disease: efficacy of the oscillometric method]. , 2011, Revista espanola de cardiologia.

[83]  T. Schroeder,et al.  Minimum training requirement in ultrasound imaging of peripheral arterial disease. , 2008, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[84]  M. O'Rourke,et al.  Arterial stiffness, systolic blood pressure, and logical treatment of arterial hypertension. , 1990, Hypertension.

[85]  W. Laing,et al.  Chronic Venous Diseases of the Leg , 1992 .

[86]  M. Jaff,et al.  Noninvasive diagnostic strategies for peripheral arterial disease. , 2006, Cleveland Clinic journal of medicine.

[87]  J. Kisslo,et al.  Principles of Doppler Echocardiography and the Doppler Examination # 1 , 2001 .

[88]  A. Nicolaides,et al.  Investigation of chronic venous insufficiency: A consensus statement (France, March 5-9, 1997). , 2000, Circulation.

[89]  M. Jenkins,et al.  Duplex scanning and effect of multisegmental arterial disease on its accuracy in lower limb arteries. , 1998, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[90]  W. Zwiebel,et al.  Introduction to Vascular Ultrasonography , 1992 .

[91]  H. Montgomery Treatment of peripheral arterial disease. , 1952, Delaware medical journal.

[92]  J. Golledge,et al.  Peripheral arterial disease - diagnosis and management in general practice. , 2013, Australian family physician.

[93]  C. Bahr CVI and PAD: A review of venous and arterial disease , 2007, JAAPA : official journal of the American Academy of Physician Assistants.

[94]  D. Strandness,et al.  PERIPHERAL VASCULAR DISEASE: DIAGNOSIS AND OBJECTIVE EVALUATION USING A MERCURY STRAIN GAUGE. , 1965, Annals of surgery.

[95]  C. M. Butler,et al.  Light reflection rheography: An effective non‐invasive technique for screening patients with suspected deep venous thrombosis , 1991, The British journal of surgery.

[96]  A. AbuRahma,et al.  Noninvasive Peripheral Arterial Diagnosis , 2010 .

[97]  F. Chappell,et al.  Ankle brachial index for the diagnosis of lower limb peripheral arterial disease. , 2016, The Cochrane database of systematic reviews.

[98]  E. Simonson,et al.  Contour of the toe pulse, reactive hyperemia, and pulse transmission velocity: group and repeat variability, effect of age, exercise, and disease. , 1955, American heart journal.

[99]  J. Hirsh,et al.  An Evaluation of Impedance Plethysmography and 125I-Fibrinogen Leg Scanning in Patients following Hip Surgery , 1989, Thrombosis and Haemostasis.

[100]  John V. White,et al.  Hemodynamic deterioration in chronic venous disease. , 1992, Journal of vascular surgery.

[101]  A. Smit,et al.  ROC analysis of noninvasive tests for peripheral arterial disease. , 1996, Ultrasound in medicine & biology.

[102]  G. Agnelli,et al.  Impedance plethysmography in the diagnosis of asymptomatic deep vein thrombosis in hip surgery. A venography-controlled study. , 1991, Archives of internal medicine.

[103]  W. Harris,et al.  Surveillance of deep vein thrombosis in asymptomatic total hip replacement patients. Impedance phlebography and fibrinogen scanning versus roentgenographic phlebography. , 1988, American journal of surgery.

[104]  J. Coleman,et al.  Sensitive electromechanical sensors using viscoelastic graphene-polymer nanocomposites , 2016, Science.

[105]  R. Langer,et al.  Quantitative and qualitative progression of peripheral arterial disease by non-invasive testing , 1999, Vascular medicine.

[106]  S. A. Fauci Harrison's Manual of Medicine , 2001 .

[107]  F. Anderson,et al.  Impedance plethysmography in the diagnosis of arterial and venous disease , 2006, Annals of Biomedical Engineering.

[108]  Igor Rudan,et al.  Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis , 2013, The Lancet.

[109]  K. Salmela,et al.  Peripheral arterial disease as a predictor of outcome after renal transplantation , 1998, Transplant international : official journal of the European Society for Organ Transplantation.

[110]  Thomas Young,et al.  I. The Croonian Lecture. On the functions of the heart and arteries , 1809, Philosophical Transactions of the Royal Society of London.

[111]  M. Jaffrin,et al.  Quantitative interpretation of arterial impedance plethysmographic signals , 2006, Medical and Biological Engineering and Computing.

[112]  Sherry L Pagoto,et al.  Sensitivity and specificity of the ankle—brachial index to diagnose peripheral artery disease: a structured review , 2010, Vascular medicine.

[113]  A A Graham Plethysmography: safety, effectiveness, and clinical utility in diagnosing vascular disease. , 1996, Health technology assessment.

[114]  S. Rosfors,et al.  Computerized venous strain-gauge plethysmography is a reliable method for measuring venous function. , 2014, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[115]  J. Cronan,et al.  Deep venous thrombosis: US assessment using vein compression. , 1987, Radiology.

[116]  Norman L. Browse Noninvasive Diagnosis of Vascular Disease , 1985 .

[117]  C. Diehm,et al.  A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease. , 2006, Journal of vascular surgery.

[118]  Alan Murray,et al.  Photoplethysmography detection of lower limb peripheral arterial occlusive disease: a comparison of pulse timing, amplitude and shape characteristics , 2005, Physiological measurement.

[119]  L. Norgren,et al.  Inter-society consensus for the management of peripheral arterial disease. , 2007, International angiology : a journal of the International Union of Angiology.

[120]  H J Terry,et al.  The evaluation of an ultrasonic flow detector for the assessment of peripheral vascular disease. , 1969, Cardiovascular research.

[121]  T Rantanen,et al.  Prevalence and risk factors of PAD among patients with elevated ABI. , 2008, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[122]  Y. K. Tan,et al.  Digital photoplethysmography in the diagnosis of suspected lower limb DVT: is it useful? , 1999, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[123]  R. C. Barker,et al.  Venous thromboembolism: risks and prevention , 2011 .

[124]  Heye Zhang,et al.  Automated Framework for Detecting Lumen and Media-Adventitia Borders in Intravascular Ultrasound Images. , 2015, Ultrasound in medicine & biology.

[125]  L. Molyneaux,et al.  TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients? , 2001, Diabetic medicine : a journal of the British Diabetic Association.

[126]  P. Bonham Measuring toe pressures using a portable photoplethysmograph to detect arterial disease in high-risk patients: an overview of the literature. , 2011, Ostomy/wound management.

[127]  M. Malone,et al.  The effect of diabetes mellitus on costs and length of stay in patients with peripheral arterial disease undergoing vascular surgery. , 2014, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[128]  B A Keagy,et al.  The role of air plethysmography in the diagnosis of chronic venous insufficiency. , 1998, Journal of vascular surgery.

[129]  J. Bergan,et al.  Venous Anatomy, Physiology, and Pathophysiology , 2007 .

[130]  Dawn Craig,et al.  Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review , 2007, BMJ : British Medical Journal.

[131]  Yuan-Ting Zhang,et al.  Investigation on Cardiovascular Risk Prediction Using Physiological Parameters , 2013, Comput. Math. Methods Medicine.

[132]  Robert Koprowski “Methods in Research and Development of Biomedical Devices” , 2014, BioMedical Engineering OnLine.

[133]  W. Hiatt,et al.  Skeletal muscle metabolic changes in peripheral arterial disease contribute to exercise intolerance: a point-counterpoint discussion , 2004, Vascular medicine.

[134]  L. J. Petersen,et al.  The toe-brachial index in the diagnosis of peripheral arterial disease. , 2013, Journal of vascular surgery.

[135]  Anita Raspovic,et al.  The reliability of toe systolic pressure and the toe brachial index in patients with diabetes , 2010, Journal of foot and ankle research.

[136]  A. Nicolaides,et al.  Air-plethysmography and the effect of elastic compression on venous hemodynamics of the leg. , 1987, Journal of vascular surgery.

[137]  M. Venermo,et al.  PAD as a risk factor for mortality among patients with elevated ABI--a clinical study. , 2010, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[138]  A Hofman,et al.  Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. , 2008, JAMA.

[139]  J. Olin,et al.  Peripheral artery disease. Part 1: clinical evaluation and noninvasive diagnosis , 2011, Nature Reviews Cardiology.

[140]  Carlos Correia,et al.  Novel Methods for Pulse Wave Velocity Measurement , 2015, Journal of Medical and Biological Engineering.

[141]  J. Cooke,et al.  Limb hemodynamics are not predictive of functional capacity in patients with PAD , 2006, Vascular medicine.

[142]  John A. Heit,et al.  Trends in the Incidence of Deep Vein Thrombosis and Pulmonary Embolism , 2006 .

[143]  R. Coleman,et al.  Detection of deep venous thrombosis by magnetic resonance imaging. , 1993, Chest.

[144]  Richard B Devereux,et al.  Relationship of High and Low Ankle Brachial Index to All-Cause and Cardiovascular Disease Mortality: The Strong Heart Study , 2004, Circulation.

[145]  Steve Goodacre,et al.  Bmc Medical Imaging Systematic Review and Meta-analysis of the Diagnostic Accuracy of Ultrasonography for Deep Vein Thrombosis , 2005 .

[146]  Leslie T Cooper,et al.  Peripheral arterial disease: diagnosis and management. , 2008, Mayo Clinic proceedings.

[147]  K. Ouriel,et al.  Developments in diagnosis and classification of venous disorders: non-invasive diagnosis. , 1999, Cardiovascular surgery.

[148]  T. Iwasaka,et al.  Risk Factors of Normal Ankle–Brachial Index and Low Toe–Brachial Index in Hemodialysis Patients , 2009, Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy.

[149]  Kirk A Easley,et al.  Diagnostic utility of the two methods of ankle brachial index in the detection of peripheral arterial disease of lower extremities , 2006, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[150]  V. Mohan,et al.  Comparison of colour duplex ultrasound and ankle-brachial pressure index measurements in peripheral vascular disease in type 2 diabetic patients with foot infections. , 2002, The Journal of the Association of Physicians of India.

[151]  E. Stankevičius,et al.  Impedance plethysmography as an alternative method for the diagnosis of peripheral arterial disease. , 2014, Medicina.

[152]  J. Cranley,et al.  Real-time B-mode venous ultrasound. , 1984, Journal of vascular surgery.

[153]  T. Orchard,et al.  Assessment of Peripheral Vascular Disease in Diabetes Report and Recommendations of an International Workshop* Sponsored by the American Diabetes Association and the American Heart Association September 18‐20, 1992 New Orleans, Louisiana , 1993, Circulation.

[154]  T. Lehtimäki,et al.  The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: requirements for diagnostics. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[155]  John Allen Photoplethysmography and its application in clinical physiological measurement , 2007, Physiological measurement.

[156]  T. Hartshorne,et al.  Peripheral vascular ultrasound : how, why and when , 2005 .

[157]  J. F. Whelan,et al.  Color flow doppler ultrasonography: Comparison with peripheral arteriography for the investigation of peripheral vascular disease , 1992, Journal of clinical ultrasound : JCU.

[158]  Strandness De,et al.  PERIPHERAL VASCULAR DISEASE: DIAGNOSIS AND OBJECTIVE EVALUATION USING A MERCURY STRAIN GAUGE. , 1965 .

[159]  J. Nyboer,et al.  Electrical Impedance Plethysmography: A Physical and Physiologic Approach to Peripheral Vascular Study , 1950, Circulation.

[160]  N. Pai,et al.  Noninvasive Evaluation of Vascular Diseases , 1999 .

[161]  M. Dauzat,et al.  Real‐time B‐mode ultrasonography for better specificity in the noninvasive diagnosis of deep venous thrombosis. , 1986, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[162]  J. Cameron,et al.  Reproducibility of Duplex Ultrasonography and Air Plethysmography Used for the Evaluation of Chronic Venous Insufficiency , 2005, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[163]  D S Miles,et al.  Assessment of peripheral hemodynamics using impedance plethysmography. , 1986, Physical therapy.

[164]  Gaetano D. Gargiulo,et al.  HeMo: Towards an inexpensive wearable peripheral blood flow monitoring device , 2015, 2015 IEEE Biomedical Circuits and Systems Conference (BioCAS).

[165]  I. Kullo,et al.  CLINICAL PRACTICE. Peripheral Artery Disease. , 2016, The New England journal of medicine.

[166]  Jennifer S. Lin,et al.  The Ankle–Brachial Index for Peripheral Artery Disease Screening and Cardiovascular Disease Prediction Among Asymptomatic Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force , 2013, Annals of Internal Medicine.

[167]  D Sapoznikov,et al.  Pulse wave velocity in healthy subjects and in patients with various disease states. , 1971, American heart journal.

[168]  T V Schroeder,et al.  Duplex ultrasound scanning of peripheral arterial disease of the lower limb. , 2010, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[169]  R. Kane,et al.  A prospective study of the efficacy of B‐scan sonography in the detection of deep venous thrombosis in the lower extremities , 1988, Journal of clinical ultrasound : JCU.

[170]  L. J. Petersen,et al.  Randomised diagnostic accuracy study of a fully automated portable device for diagnosing peripheral arterial disease by measuring the toe-brachial index. , 2013, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[171]  J. Giri,et al.  Anatomic correlates of supra‐normal ankle brachial indices , 2013, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[172]  S. Rosfors,et al.  Asymptomatic deep venous thrombosis is associated with a low risk of post-thrombotic syndrome. , 2009, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[173]  R. Kirsner,et al.  Dermatologic complications of chronic venous disease: medical management and beyond. , 2007, Annals of vascular surgery.

[174]  J. Gardin,et al.  Guidelines for noninvasive vascular laboratory testing: a report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology. , 2006, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[175]  N. Lassen,et al.  Healing of ulcers on the feet correlated with distal blood pressure measurements in occlusive arterial disease. , 1980, Acta orthopaedica Scandinavica.

[176]  K. Harding,et al.  An evaluation of the efficacy of methods used in screening for lower-limb arterial disease in diabetes. , 2005, Diabetes care.

[177]  E. Alegría-Barrero,et al.  Diagnosis of Peripheral Vascular Disease: Current Perspectives , 2015 .

[178]  T. Carman,et al.  Diagnostic approach to peripheral arterial disease. , 2011, Cardiology clinics.