Aim: assess the added value of B-flow technique in assessment of lower limb arterial lesions in presence of densely calcified atheromatous plaques.

Patients and methods: Our study included 30 cases, all have densely calcified arterial atheromatous plaques. All subjects were examined by CDU with spectral analysis and BFI; and the results were compared to the gold standard CTA.

Results: BFI has higher discrimination than CDU in presence of densely calcified plaques at the femoral segments. It is also better in detecting sites of collaterals take-off at the infra-popliteal segments. However, extensively calcified plaques, depth and edema represent major limitations.

Conclusion: B-flow has the potential to improve US imaging in patients with PAD. However, it is not free of limitations. As such, we do not encourage the use of B-Flow as a sole ultrasound imaging mode, but as a complementary technique to use in situations where CDU findings are inconclusive or unclear.