Evaluation of the symptomatic patient consists of duplex scanning. Peak systolic velocities (PSV) in excess of 130 cm/s to 325 cm/s suggest significant stenosis. Huston et al report that PSV > 230 cm/s has a sensitivity of 86%, sensitivity of 90% and positive predictive value of 82% of identifying stenosis > 70%. An end diastolic velocity of > 70 cm/s suggests stenosis > 70 (Table 18.2).1

Angiography as discussed in earlier has inherent risk of stroke (1%) and does not offer and advantage in the diagnosis. This is a topic of discussion with recent reports

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