Investigating the early diagnostic value of popliteal artery wall shear stress in lower extremity arterial disease in type 2 diabetes patients using color Doppler ultrasound combined with WSS quantitative analysis

Abstract Background The global increase in type 2 diabetes mellitus (T2DM) has contributed to a growing burden of lower extremity arterial disease (LEAD), often detected at advanced stages due to limitations in current diagnostic methods. While the ankle-brachial index (ABI) is widely used, it provides no structural information; advanced imaging such as DSA, CTA, or MRA involves radiation, contrast agents, or high cost. Color Doppler ultrasound (DUS) offers a non-invasive and economical alternative for hemodynamic assessment. This study proposes an integrated approach combining DUS with custom MATLAB-based software to quantify wall shear stress (WSS) in the popliteal artery, aiming to establish WSS as a potential early marker of LEAD in T2DM patients. Results In a study comparing T2DM patients to controls, T2DM groups showed significantly altered blood pressure, blood lipids, and blood viscosity, along with reduced WSS values, indicating advanced arterial damage. Specifically, WSS was lower in T2DM groups with normal and thickening IMT and those with plaque formation compared to controls. The optimal WSS cutoff for predicting LEAD was 1.82 dyne/cm 2 , with a sensitivity of 68% and specificity of 83%. WSS negatively correlated with factors like age and disease duration, and positively with peak systolic velocity (PSV). Conclusions Non-invasive WSS measurement using DUS provides a valuable diagnostic tool for early LEAD detection in T2DM patients. Reduced WSS in the popliteal artery is a predictive marker of disease onset, offering potential for earlier intervention and better management of LEAD, ultimately improving patient outcomes.