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• W4245497429 abstract "We thank the authors for their interest in our article and for their valuable comments. Their experience suggests that it makes clinical sense to perform Duplex scanning also after exercise, with the aim to uncover vascular stenosis not seen at rest. It is established clinical practice to elicit a pressure decrease across an iliac artery stenosis by inducing increased flow by using intra-arterial papaverine, to identify hemodynamically significant obstruction. The increased flow also results in increased Δ^ PSV at the site of the stenosis. 1Elsman B.H. Legemate D.A. de Vos H.J. Mali W.P. Eikelboom B.C. Hyperemic colour duplex scanning for the detection of aortoiliac stenoses. A comparative study with intra-arterial pressure measurement.Eur J Vasc Endovasc Surg. 1997; 14: 462-467Abstract Full Text PDF PubMed Scopus (11) Google Scholar However, hyperemic duplex scanning of the aortoiliac arteries is more difficult to perform than duplex scanning at rest because most patients are breathing heavily after exercise. The lower pressure distal to the obstruction, it seems, may also affect the more distal duplex flow pattern. There might be a certain point at which the large pressure decrease would affect the flow significantly and would also affect the resistance of the vascular bed significantly. Therefore, the normal duplex waveform at the common femoral artery measured at rest may become abnormal (monophasic) after exercise. It is known that, for the same reason, patients can have a normal ankle-brachial index in rest, whereas it decreases after reactive hyperemia. Although more research is needed to prove this point, we agree that the addition of exercise testing may indeed increase the sensitivity of the Duplex waveform for detecting aortoiliac stenotic disease. Regarding “Value of the duplex waveform at the common femoral artery for diagnosing obstructive aortoiliac disease”Journal of Vascular SurgeryVol. 43Issue 2PreviewWe read with interest the article the value of femoral duplex waveform for diagnosing aortoiliac arterial disease by Spronk et al.1 Although it is known that spectral Doppler waveforms beyond a critical stenosis or occlusion may appear normal (triphasic or biphasic) at rest, they often become abnormal when reactive hyperemia is used.2 Full-Text PDF Open Archive" @default.
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