PERIPHERAL

Peripheral arterial circulation supplies mm tissues of upper/lower extremities

Can be anterograde and retrograde waves
Pulse wave reflection can occur at branch sites (Ao bifurcation, branches)
Systolic component is produced by LV contraction via ascending aorta resulting in rapid increase in volume and velocity.
Diastolic component reflects the vasoconstriction present in the resting mm beds.
- High resistive beds can display a retrograde/reflected wave in early diastole.
- A small antegrade component may be present in mid- to late- diastole as a result of an antegrade wave generated by proximal compliant large and medium arteries.
Conditions that increase flow to limb do so via arteriole dilation in the mm bed allowing forward flow throughout diastole
- Exercise
- Increased limb temperature
- AVF
Although Doppler waveform generally demonstrates a narrow spectral bandwidth, some light incrase in spectral broadening may be noted

INFLOW ARTERIES

Lower: common, external, and internal iliac artery
Upper: innominate, subclavian
Minimally increased spectral boadening may be seen in internal iliac artery 2/2 size of Doppler sample volume and smaller vessel diameter compared to common and external iliac arteries.

OUTFLOW ARTERIES

Lower: common femoral, profunda femoris (deep femoral), superficial femoral, and popliteal artery
Upper: axillary and brachial artery
In normal thigh arteries, there may be a slight decrease in PSV compared to PSV in the normal inflow arteries.

RUN-OFF ARTERIES

Lower: anterior tibial, posterior tibial, peroneal artery
Upper: radial, ulnar artery
Spectral bandwidth remains consistent w laminar flow although a slight increase in spectral broadening may be noted secondary to the size of the Doppler sample volume and small vessel diameters.
No significant difference is noted in PSV among the 3 calf or 2 forearm arteries.

PLANTER, PALMAR, DIGITAL ARTERIES

The flow pattern remains laminar, although a slight increase in the PW spectral bandwidth may be noted secondary to the size of the Doppler sample volume and the small diameter of the plantar and digital arteries.

PHYSIOLOGIC EFFECTS

The increased flow demand and decreased vascular resistance associated with exercising muscle, increased body temperature, or focal inflammation results in continuous forward flow.

PSV can increase significantly (e.g. external iliac artery) as a result of exercise, even when the artery is normal.

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