Assessing the Severity of Peripheral Arterial Disease: Doppler Ultrasound Compared to Digital Subtraction Angiography in Distal Limb Arteries

ABSTRACT Introduction Accurate and timely diagnosis of peripheral arterial disease (PAD) is essential to prevent progression and guide effective treatment. This study aims to compare the diagnostic accuracy and limitations of Doppler ultrasonography (DUS) and digital subtraction angiography (DSA) in evaluating the severity and anatomical distribution of PAD, particularly in infra‐popliteal arteries, to improve diagnostic decision‐making in vascular care. Methods This cross‐sectional study involved 40 PAD patients scheduled for lower limb revascularization. All participants underwent both DUS and DSA. DUS was performed by experienced sonographers using a standardized protocol to assess both supra‐ and infra‐popliteal arteries, while DSA was conducted during the procedure with contrast‐enhanced x‐ray imaging. Diagnostic performance and concordance between DUS and DSA were analyzed using chi‐square tests, Kappa coefficient, and correlation (Pearson and Spearman). Results A total of 504 arterial sections were analyzed. The concordance between DUS and DSA was 63.5% for supra‐popliteal arteries and 34.9% for infra‐popliteal arteries. DUS demonstrated higher diagnostic accuracy in the supra‐popliteal regions, with a positive predictive value (PPV) of 83.2% and a negative predictive value (NPV) of 85.4%. However, in infra‐popliteal arteries, the PPV and NPV were lower (68.5% and 72.3%, respectively), indicating reduced reliability in detecting distal arterial lesions. Conclusion DUS is a valuable non‐invasive tool for assessing PAD in supra‐popliteal arteries but has limited accuracy in infra‐popliteal evaluations. Supplementary imaging modalities such as DSA remain essential for precise diagnosis and treatment planning in distal arterial disease.