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

Elham Shabani Varaki, Gaetano D Gargiulo, Stefania Penkala, Paul P Breen, Elham Shabani Varaki, Gaetano D Gargiulo, Stefania Penkala, Paul P Breen

Abstract

Background: Worldwide, 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 body: This 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.

Conclusion: This 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.

Keywords: Ankle Brachial Index; Chronic venous insufficiency; Deep vein thrombosis; Doppler ultrasound; Peripheral arterial disease; Plethysmography.

Figures

Fig. 1
Fig. 1
Examples of peripheral vascular function assessment in the lower limb using plethysmography techniques; a strain gauge plethysmography [37]; b photo plethysmography (PPG); c quantitative PPG/light reflection rheography (LRR); d Impedance Plethysmography, modified from [38]; e Air Plethysmography (APG) [39]
Fig. 2
Fig. 2
Schematic view of the use of impedance plethysmography for detection of DVT (adapted from [36])
Fig. 3
Fig. 3
VOTI system and its sandal shaped measuring probe [165]
Fig. 4
Fig. 4
HeMo prototype; a a demonstration of HeMo worn on the calf [166]; b HeMo cuff (adopted from  [166]); c diagram of HeMo worn on the calf (adopted from [166]); d blood flow variations recorded before, during and after tiptoe exercise by HeMo [167]
Fig. 5
Fig. 5
Advent of milestone technologies for noninvasive diagnosis of PVDs

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