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.

Source: SVU-SVM peripheral arterial waveform consensus / IAC

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.

Source: KDOQI 2019 / AIUM postoperative hemodialysis access / ACR-AIUM-SRU

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