Arterial Doppler — limbs and arteriovenous fistula
Arterial Doppler — limbs and arteriovenous fistula — Reference values: Abdominal aorta — diameter, Common iliac artery — diameter, Common femoral artery — diameter.
Integrated category for lower-limb arterial Doppler, upper-limb arterial Doppler, pre-creation mapping for arteriovenous fistula and evaluation of a working arteriovenous fistula. Stenosis cutoffs by velocity ratio are practical and widely used, but may vary by laboratory, segment, graft, stent, Doppler angle and collateral circulation.
Measurements and reference values
Measurement
Usual value
Note
Abdominal aorta — diameter
< 3 cm
≥ 3 cm = aneurysmSource: Merck / USPSTF
Common iliac artery — diameter
≈ 8–10 mm
Source: J Vasc Surg 1993
Common femoral artery — diameter
≈ 5–9 mm
Source: Doppler US (ResearchGate)
Lower-limb arterial protocol
aorta, iliac, femoral, popliteal, tibial and dorsalis pedis arteries
Document peak systolic velocity, spectral waveform, color/aliasing and comparison with a normal proximal segment. When there is a focal jet, calculate the velocity ratio.Source: IAC Vascular Testing / StatPearls / SVU-SVM waveform consensus
Upper-limb arterial protocol
subclavian, axillary, brachial, radial, ulnar and palmar arch when indicated
For arteriovenous fistula planning, assess dominance, patency, calcification, diameter, reactive hyperemia and radial-ulnar/palmar communication according to local protocol.Source: ACR-AIUM-SRU vessel mapping / AIUM preoperative dialysis access
Pre-fistula mapping — donor artery
> 2,0 mm
Arterial diameter above 2.0 mm is a common target for native arteriovenous fistula; below that, decisions depend on pulse, calcification, reactive hyperemia and surgical strategy.good candidate: >2.0 mm and no limiting calcificationgray zone: 1,5–2,0 mmhigh technical risk: <1.5 mm, occlusion or marked calcificationSource: KDOQI 2019 review / ACR-AIUM-SRU / AIUM
Pre-fistula mapping — superficial vein
> 2,5 mm
Vein above 2.5 mm is a common target for arteriovenous fistula; for grafts, many protocols use vein above 4.0 mm. Compressibility, continuity and depth are as important as diameter.favorable for fistula: >2.5 mm, compressible and continuousborderline: 2,0–2,5 mm ou profundidade > 6 mmunfavorable: <2.0 mm, thrombosis or noncompressibleSource: KDOQI 2019 review / AIUM / ACR-AIUM-SRU
Working arteriovenous fistula — access flow
interpret with trend and clinical context mL/min
Older practical rules use 600 mL/min as a maturation target, but modern guidance emphasizes physical examination, dialysis performance, flow trend and focal stenosis findings.Source: KDOQI 2019 / AIUM postoperative hemodialysis access
Classifications and calculators
Interactive assistant — stenosis, waveform and arteriovenous fistula
Input
Output
How to use
Velocity ratio <1.5 and multiphasic waveform
Green
Favors no hemodynamically relevant stenosis in the analyzed segment.
Ratio 1.5-1.99 or isolated biphasic/monophasic waveform
Yellow
Borderline zone: confirm angle, sampling at the jet, proximal reference segment and contralateral comparison.
Ratio >=2, distal tardus-parvus waveform, absent flow or thrombosis
Red
Treat as abnormal until proven otherwise; document location, highest velocity, ratio and distal waveform.
Fill the cells below to obtain velocity ratio, likely stenosis grade, waveform reading, tardus-parvus suspicion and arteriovenous fistula triage.
Source: StatPearls/NCBI / Society for Vascular Medicine / SVU-SVM / KDOQI
Peripheral arterial stenosis by velocity ratio
Interpretation
Velocity ratio
Note
No relevant stenosis
< 1,5
Multiphasic waveform and no focal aliasing favor normality in the segment.
Likely mild stenosis
1,5–1,99
Often estimated as 30-49%; confirm technique and avoid overcalling in isolation.
Hemodynamically significant stenosis
2,0–4,0
Compatible with at least 50% stenosis in many protocols; look for focal jet, turbulence and distal change.
Severe stenosis
> 4,0
Suggests greater than 75-80% stenosis when sampling is correct and morphology agrees.
Occlusion
no demonstrable flow
Confirm gain, scale, angle and collaterals before concluding; distal waveform may be reconstituted by collaterals.
Ratio = peak systolic velocity at the jet or suspicious point divided by peak systolic velocity in the normal proximal segment. Specific segments, stents and grafts may require their own criteria.
Source: StatPearls/NCBI Bookshelf / Society for Vascular Medicine / IAC
Peripheral arterial waveform patterns
Pattern
Color
Practical meaning
Multiphasic with rapid systolic upstroke
Green
Expected pattern in healthy peripheral arteries, especially at rest.
Biphasic with preserved amplitude
Yellow
May be acceptable in some older patients or after vasodilation, but deserves comparison and context.
Low-resistance monophasic with still rapid upstroke
Yellow
May occur distally after exercise, inflammation, hyperemia or fistula; it is not always proximal stenosis.
Damped monophasic or tardus-parvus
Red
Slow upstroke, rounded peak and low amplitude suggest inflow disease or proximal stenosis.
Absent flow where flow should be present
Red
Consider occlusion, thrombosis, severe spasm or technical error; confirm with color, power Doppler and spectral Doppler.
Arteriovenous fistula — pre-creation and follow-up
Scenario
Green
Yellow
Red
Donor artery
>2.0 mm, patent, adequate pulse and no limiting calcification
1.5-2.0 mm or weak reactive hyperemia
<1.5 mm, occlusion, severe calcification or relevant steal
Candidate superficial vein
>2.5 mm, compressible, continuous and favorable depth
2.0-2.5 mm, depth >6 mm or short segment
<2.0 mm, thrombosis, sclerosis or noncompressible
Working fistula — access flow
Functional, stable trend and usually >600 mL/min
400-600 mL/min, progressive drop or very high flow without symptoms
<400-500 mL/min with dysfunction, thrombosis, nonmaturation or very high flow with cardiac impact
Fistula stenosis
No focal jet, no critical turbulence and favorable physical examination
Focal jet with ratio 2-3 or isolated finding without flow drop
Ratio >3, marked jet, post-stenotic change, thrombus, aneurysm/pseudoaneurysm or clinical change
Intervention decisions in hemodialysis access should not depend on a single velocity: integrate physical examination, cannulation difficulty, dialysis venous pressure, flow decline, arm swelling and access history.