Can ultrasound replace arteriography in the management of chronic arterial occlusive disease of the lower limb?

Abstract

Objectives: to investigate whether colour duplex scanning can be used as the sole diagnostic investigation prior to lower limb revascularisation. Patients and Methods: the results of angiography and duplex were compared in 80 limbs (69 claudication, 11 critical limb ischaemia [CLI]) from 68 patients. Results: excellent diagnostic agreement (κ value 0.89, 95% CI 0.85-0.93) was achieved at the femoropopliteal segment. Agreement was good for the aorto-iliac segment (κ value 0.69, 95% CI 0.61-0.77) and moderate for the infrapopliteal segment (κ value 0.59, 95% CI 0.55-0.63). Similarly, in the decision-making process excellent agreement was achieved for the femoropopliteal segment (κ value 0.91, 95% CI 0.88-0.94), good for the aortoiliac segment (κ value 0.62, 95% CI 0.56-0.68), and moderate for the infrapopliteal segment (κ value 0.46, 95% CI 0.42-0.50). Duplex detected patent 12 tibial arteries in 10 limbs that were not opacified on arteriography. In four limbs duplex revealed significant disease in the above knee popliteal artery that was missed on arteriography. Conclusions: treatment of femoropopliteal disease can be based upon duplex alone in the great majority of cases. However, where there is disease in the aortoiliac segment, or where infrapopliteal revascularisation is long considered both duplex and angiography should be performed to maximise pre-operative information.