WHAT TO EXPECT
In-House Diagnostic Imaging
Answers shouldn't require a second facility. We run a full diagnostic ultrasound lab right in our office, so your evaluation, your imaging, and your treatment plan all happen in one practice. When your first visit shows a blockage is likely, your ultrasound, your procedure (an angiogram), and your follow-up visit are each scheduled before you leave. Our staff obtains insurance authorization in the background.
Our in-house ultrasound services
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Echocardiography — ultrasound of the heart's structure and pumping function
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Carotid ultrasound — screening the neck arteries for stroke risk
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Arterial (vascular) ultrasound — mapping circulation in the legs and arms
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Venous ultrasound — checking the veins for clots and reflux
A sharper way to catch circulation problems early: pedal ultrasound & PAT
Standard leg circulation tests can miss disease in the small arteries of the foot. We use pedal (foot-level) ultrasound with pedal acceleration time (PAT) — a focused measurement of blood flow reaching the foot. It detects trouble earlier, stays reliable when calcified arteries make tests like the ankle-brachial index unreliable, and is built for limb salvage. Crucially, it can be measured even next to an open wound or after a toe amputation — situations where toe-pressure and skin-oxygen tests can’t be used — so we can still gauge blood flow exactly where it matters. Peripheral Artery Disease → Diabetic Foot & Wounds → All six ultrasound studies →
Why we start with complete arterial duplex — not ABI alone
The ankle-brachial index (ABI) is a useful screen, but it misses a great deal of disease in exactly the patients who need detection most — because stiff, calcified arteries can give a normal or falsely high reading even when serious blockages are present. So every patient with suspected PAD or a threatened limb gets a complete arterial duplex ultrasound — aortoiliac through the pedal arteries, with waveform analysis that detects disease even in calcified vessels.
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Complete duplex maps the location and severity of disease — and the pedal targets — in one painless study with no radiation, contrast, or needles, so the interventionalist can plan the case before the patient reaches the lab. Improvement in pedal acceleration time (PAT) after revascularization has been associated with limb salvage: in a single-center series of 73 threatened limbs, every one of the 59 limbs that were saved showed a two-class improvement in PAT, while the 14 limbs whose PAT did not improve went on to above-ankle amputation.
Choosing an imaging test: duplex, CTA, or MRA
The 2024 ACC/AHA PAD Guideline gives a Class I recommendation to duplex ultrasound, CT angiography, MR angiography, or catheter angiography for planning revascularization in both claudication and CLTI — four equally acceptable options, with the choice individualized to the patient and the resources at hand. Duplex is not singled out. Each test trades something away:
Test
What it gives up
Who it is hardest on
CT angiography (CTA)
Iodinated contrast and ionizing radiation. Dense tibial and pedal calcification can bloom on CT and obscure the very vessels that decide whether a wound heals.
Patients with reduced kidney function; patients with heavily calcified below-the-knee arteries — often the same patients.
MR angiography (MRA)
Gadolinium contrast, longer scan times, and difficulty for patients who cannot lie still or who have certain implanted devices. Tends to overstate the severity of narrowings.
Patients with advanced kidney disease, claustrophobia, or implanted hardware.
Arterial duplex ultrasound
Lower spatial resolution than CTA or MRA. Depends heavily on the skill of the technologist and on unhurried scanning time — a full aortoiliac-to-pedal study is not a quick test.
Patients with extensive bowel gas, open dressings over the vessel, or very large body habitus.
We start with a complete arterial ultrasound, including pedal imaging and PAT, and reach for CTA or MRA when duplex cannot answer the question. Three reasons drive that order:
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No contrast, no radiation. A large share of the patients we see have chronic kidney disease, and many will need iodinated contrast again in the procedure room. We would rather spend none of that budget on a diagnostic scan. Kidney-safe angiography →
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Calcification does not blind it. Waveform analysis reads flow, not the vessel wall. Where calcium defeats the ankle-brachial index and confounds CT, duplex still reports what is reaching the foot.
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It can be measured at the wound. PAT can be taken beside an open ulcer or after a toe amputation — precisely where toe pressures and skin-oxygen measurements cannot be obtained.
We answer to the resolution limit honestly: when the anatomy above the knee is in question, or when duplex is inconclusive, cross-sectional imaging is the right tool and we order it. The guideline permits either. What it does not permit is skipping the arterial study because an ABI came back normal.