Many modalities, including ultrasound, spiral CT, MR angiography, and arteriography, are used to detect and evaluate peripheral vascular disease. Arteriography is the gold standard and provides exquisite anatomic detail, but because it is invasive, and requires ionizing radiation and administration of iodinated contrast, it is not useful for screening purposes. Other limitations of arteriography are that it provides no physiologic or functional information, and it cannot be used for serial evaluations.

Desirable qualities for a screening modality are that it should be sensitive to detect disease and to determine the hemodynamic significance for a lesion. It should also be able to distinguish severe stenoses from those not requiring intervention.

Ultrasound is an ideal screening modality for evaluating peripheral arteries, because it not only fulfills each of the previous requirements, but also because it is noninvasive and does not involve administration of contrast material or radiation. In addition, it provides physiologic and anatomic information, and in comparison with CT, MR imaging, and angiography, it is relatively inexpensive. It is also valuable because it can evaluate known stenoses serially and determine the response to a variety of therapies, such as bypass grafting, angioplasty, and stent grafts.

This article reviews the current role of ultrasound with respect to diagnosis and treatment of lower-extremity arterial disease.