1
|
Martinelli O, Alunno A, Jabbour J, Cuozzo S, Gattuso R. Duplex Ultrasound as a reliable alternative to CT angiography for treatment planning of Peripheral Artery Disease. INT ANGIOL 2021; 40:306-314. [PMID: 33832186 DOI: 10.23736/s0392-9590.21.04524-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this work is to compare the diagnostic accuracy of Duplex ultrasound (DUS) and CT angiography (CTA) in the study of arterial vessels, in patients with chronic peripheral arterial disease (PAD) of the lower limbs to undergo endovascular revascularization with the use of intraprocedural digital angiography (DSA). METHODS 94 patients with obstructive pathology of the arterial axes of the lower limbs were enrolled in the study. In all patients, endovascular revascularization treatment was considered the most suitable therapeutic choice. For this reason, ultrasound and CTA was performed preoperatively in all and based on the data obtained it was decided to classify the arterial tree into five segments: iliac, common femoral, superficial femoral, popliteal and infra-geniculate. According to the degree of stenosis or occlusion, the arteries were scored in no stenotic, stenotic and occluded. The comparison of the data provided by the DUS and the CTA was carried out with reference to the parameters obtained by the DSA. RESULTS The results of our experience have shown that in the iliac arterial district DUS proved to be less accurate than CT angiography when compared to DSA (Cohen's Kappa agreement of 0.91 and 1.0, respectively). Good diagnostic concordance were found in the femoro-popliteal district (Cohen's Kappa agreement 33 between 0.96 and 0.93). On the contrary, when the data of the infra-geniculate area were compared, CT angiography showed a net deficiency compared to DSA and DUS (Cohen's k: 0.75). CONCLUSIONS Due to its accuracy, high-quality DUS performed by well-trained operators may therefore represent a good alternative to CTA in patients undergoing endovascular revascularization, in order to reduce the use of contrast-enhanced radiological imaging especially when a condition of intolerance to the contrast medium and/or renal insufficiency coexists.
Collapse
Affiliation(s)
- Ombretta Martinelli
- Vascular Surgery Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alessia Alunno
- Vascular Surgery Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy -
| | - Jihad Jabbour
- Vascular Surgery Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Simone Cuozzo
- Vascular Surgery Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Roberto Gattuso
- Vascular Surgery Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
2
|
Martinelli O, Alunno A, Drudi FM, Malaj A, Irace L. Duplex ultrasound versus CT angiography for the treatment planning of lower-limb arterial disease. J Ultrasound 2020; 24:471-479. [PMID: 33165702 DOI: 10.1007/s40477-020-00534-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study aimed to assess the diagnostic accuracy of duplex sonography (DUS) compared with that of computed tomography angiography (CTA) in detecting occlusion and stenosis in peripheral arterial disease (PAD) in candidate patients for endovascular revascularization with intraprocedural digital subtraction angiography (DSA). METHODS The study involved 94 patients suffering from PAD who were candidates for endovascular procedures requiring DSA. They were all submitted preoperatively to DUS and CTA. Based on image analysis, five segments of the arterial tree were assessed: iliac, common femoral, superficial femoral, popliteal, and infrageniculate. According to the stenosis or occlusion degree, the arteries were rated as nonstenotic, stenotic, and occluded. RESULTS The agreement between DUS and CTA findings using DSA as a reference modality was expressed as a Cohen's kappa (κ) statistic agreement. Our results show that DUS has been less accurate than CTA in evaluating iliac arterial diseases (Cohen's κ agreement of 0.91 and 1.0, respectively) when measured against DSA. We found good diagnostic concordance between DUS and DSA in detecting hemodynamic stenosis and occlusion of the femoro-popliteal axis (Cohen's κ agreement between 0.96 and 0.93). Below the knee, CTA showed even less concordance with DSA (Cohen's κ 0.75). CONCLUSIONS Because of its accuracy, high-quality DUS performed by well-trained operators may therefore represent a good alternative to CTA in patients undergoing endovascular revascularization to minimize the use of contrast-enhanced radiological imaging. Nevertheless, preoperative CTA imaging is required in cases of nondiagnostic DUS or when a more complete overview of the vascular tree is needed for complex invasive interventions.
Collapse
Affiliation(s)
- Ombretta Martinelli
- Vascular Surgery Department, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Alessia Alunno
- Vascular Surgery Department, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - Francesco Maria Drudi
- Radiology Department, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Alban Malaj
- American Hospital of Tirana, Tirana, Albania
| | - Luigi Irace
- Vascular Surgery Department, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| |
Collapse
|
3
|
Schiele F, Navarese EP, Visoná A, Ray K. What imaging techniques should be used in primary versus secondary prevention for further risk stratification? ATHEROSCLEROSIS SUPP 2017; 26:36-44. [DOI: 10.1016/s1567-5688(17)30023-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
4
|
D'Abate F, Ramachandran V, Young MA, Farrah J, Ahmed MH, Jones K, Hinchliffe RJ. B-Flow Imaging in Lower Limb Peripheral Arterial Disease and Bypass Graft Ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2345-2351. [PMID: 27222245 DOI: 10.1016/j.ultrasmedbio.2016.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/06/2016] [Accepted: 04/11/2016] [Indexed: 06/05/2023]
Abstract
Doppler ultrasonography plays a key role in the diagnosis of peripheral arterial disease, but is often limited by pitfalls that may be overcome by B-flow imaging. Thus far, there is little information on B-flow imaging for the assessment of peripheral arterial disease and bypass grafts in lower limbs. This article describes the authors' early experience with B-flow in the lower extremities. Sixty patients were included among a large cohort of patients routinely referred to the vascular laboratory for peripheral arterial disease and bypass graft assessments. Two experienced vascular sonographers performed all scans, comparing color Doppler ultrasonography with B-flow imaging. All scans were performed using a combination of the 9 L linear and C2-9 curvilinear transducers with the LOGIQ E9 system (GE Healthcare, Waukesha, WI, USA). Our experience indicates that this relatively unexplored technology has the potential to significantly improve peripheral blood flow evaluation. Nevertheless, B-flow imaging is not exempt from limitations and should be considered complementary to color Doppler ultrasonography.
Collapse
Affiliation(s)
- Fabrizio D'Abate
- St. George's Vascular Laboratory-Vascular Institute, St. George's Healthcare NHS Trust, London, United Kingdom.
| | - Veni Ramachandran
- St. George's Vascular Laboratory-Vascular Institute, St. George's Healthcare NHS Trust, London, United Kingdom
| | - Mark A Young
- St. George's Vascular Laboratory-Vascular Institute, St. George's Healthcare NHS Trust, London, United Kingdom
| | - John Farrah
- St. George's Vascular Laboratory-Vascular Institute, St. George's Healthcare NHS Trust, London, United Kingdom
| | - Mudasar H Ahmed
- St. George's Vascular Laboratory-Vascular Institute, St. George's Healthcare NHS Trust, London, United Kingdom
| | - Keith Jones
- St. George's Vascular Laboratory-Vascular Institute, St. George's Healthcare NHS Trust, London, United Kingdom
| | - Robert J Hinchliffe
- Bristol Centre for Surgical Research, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
5
|
Guía de práctica clíníca de la ESC sobre diagnóstico y tratamiento de las enfermedades arteriales periféricas. Rev Esp Cardiol 2012. [DOI: 10.1016/j.recesp.2011.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
6
|
Baumann F, Willenberg T, Do DD, Keo HH, Baumgartner I, Diehm N. Endovascular Revascularization of Below-the-Knee Arteries: Prospective Short-Term Angiographic and Clinical Follow-Up. J Vasc Interv Radiol 2011; 22:1665-73. [DOI: 10.1016/j.jvir.2011.08.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 08/26/2011] [Accepted: 08/30/2011] [Indexed: 10/16/2022] Open
|
7
|
Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, Cremonesi A, De Carlo M, Erbel R, Fowkes FGR, Heras M, Kownator S, Minar E, Ostergren J, Poldermans D, Riambau V, Roffi M, Röther J, Sievert H, van Sambeek M, Zeller T. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:2851-906. [PMID: 21873417 DOI: 10.1093/eurheartj/ehr211] [Citation(s) in RCA: 1045] [Impact Index Per Article: 80.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
-
- 3rd Division of Cardiology, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Schmidt A, Ulrich M, Winkler B, Klaeffling C, Bausback Y, Bräunlich S, Botsios S, Kruse HJ, Varcoe RL, Kum S, Scheinert D. Angiographic patency and clinical outcome after balloon-angioplasty for extensive infrapopliteal arterial disease. Catheter Cardiovasc Interv 2010; 76:1047-54. [DOI: 10.1002/ccd.22658] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
9
|
Kakkos SK, Tsolakis IA. Is duplex ultrasound scanning for peripheral arterial disease of the lower limb a non-invasive alternative or an adjunct to angiography? Eur J Vasc Endovasc Surg 2010; 40:513-4. [PMID: 20719549 DOI: 10.1016/j.ejvs.2010.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 07/16/2010] [Indexed: 11/16/2022]
Affiliation(s)
- S K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
| | | |
Collapse
|
10
|
Emerging Evidence for Neuroischemic Diabetic Foot Ulcers: Model of Care and How to Adapt Practice. INT J LOW EXTR WOUND 2009; 8:82-94. [DOI: 10.1177/1534734609336948] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although neuropathic ulceration remains the commonest type of foot ulcers among patients with diabetes, recent data suggest that ischemic (and therefore, neuroischemic) ulcers are on the rise. The high prevalence and incidence of diabetes and its attendant foot complications, coupled with the current trend where increasingly diabetes care is being provided by general practitioners (primary care physicians) would mean that primary care practices are expected to see greater numbers of diabetic foot ulcer patients. Unfortunately, these settings are frequently ill-equipped to appropriately manage diabetic foot ulcers either due to lack of adequately trained personnel and access to multidisciplinary foot care teams. Whereas neuropathic foot ulceration may appear to be less challenging, neuroischemic or ischemic ulcers portend a higher risk of adverse outcomes, including non-healing, infection, amputation, and death. The last 2 decades have witnessed a paradigm shift from neuropathy as the main etiological factor in diabetic foot disease to an ever-increasing preponderance of ischemic and/or neuroischemic ulceration. Available literature does not always consider the limited access primary care practices have to specialized multidisciplinary foot care teams. Additionally, in the case of neuroischemic and/or ischemic ulcers, existing guidelines on their diagnosis and management are varied and unclear. This review aimed at providing a simple understanding to the complex evidence base for diagnosing and treating neuroischemic and/or ischemic ulcers in a primary care setting. It emphasizes the need for urgent vascular review in all patients with ischemic/ neuroischemic ulcers and advocates effective participation of vascular specialists in diabetic foot clinics and combined ward rounds.
Collapse
|
11
|
Langer S, Krämer N, Mommertz G, Koeppel TA, Jacobs MJ, Wazirie NA, Ocklenburg C, Spüntrup E. Unmasking pedal arteries in patients with critical ischemia using time-resolved contrast-enhanced 3D MRA. J Vasc Surg 2009; 49:1196-202. [DOI: 10.1016/j.jvs.2008.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 12/15/2008] [Accepted: 12/15/2008] [Indexed: 10/20/2022]
|
12
|
Diehm N, Pattynama P, Jaff M, Cremonesi A, Becker G, Hopkins L, Mahler F, Talen A, Cardella J, Ramee S, van Sambeek M, Vermassen F, Biamino G. Clinical Endpoints in Peripheral Endovascular Revascularization Trials: a Case for Standardized Definitions. Eur J Vasc Endovasc Surg 2008; 36:409-19. [DOI: 10.1016/j.ejvs.2008.06.020] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 06/14/2008] [Indexed: 11/25/2022]
|
13
|
Abstract
FOR THE DIAGNOSIS OF AN ARTERIOPATHY: The approach is basically clinical, and vascular explorations are represented by the measurement of ankle blood pressure and calculation of the pressure index, a simple test that should systematically complete the examination. THE SEARCH FOR LOCAL LESIONS OF POTENTIALLY POOR PROGNOSIS: These are principally aneurysm and stenosis of the derivation routes that should be searched for using a Doppler in order to localise them and, completed by measurement of ankle blood pressure, specify the upstream impact and the ultrasound-Doppler analysis of certain selected areas. BEFORE REVASCULARISATION: The arteriography, examination of reference until recently, has certain limits that explain its more restricted use and the widened use of ultrasound-Doppler explorations, combined with magnetic resonance imaging and scanning.
Collapse
Affiliation(s)
- Philippe Lacroix
- Unité fonctionnelle de médecine vasculaire, Service de chirurgie thoracique et cardiovasculaire et de médecine vasculaire, Hôpital Dupuytren, CHU de Limoges
| | | | | | | |
Collapse
|
14
|
Coffi SB, Ubbink DT, Zwiers I, van Gurp JAM, Hanson D, Legemate DA. Contrast-enhanced duplex scanning of crural arteries by means of continuous infusion of Levovist. J Vasc Surg 2004; 39:517-22. [PMID: 14981441 DOI: 10.1016/j.jvs.2003.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To estimate the dosage needed for continuous infusion and to investigate whether continuous infusion of the ultrasound contrast-enhancing agent Levovist (SH U 508A) can improve duplex scanning of crural arteries in patients with peripheral arterial obstructive disease (PAOD) eligible for distal bypass graft surgery. DESIGN, PATIENTS, AND METHODS The study design consisted of two parts. Part 1 investigated the color and spectral Doppler scan enhancement of three different Levovist dosages (200, 300, and 400 mg/mL) in one arterial segment of a patent lumen of a crural artery in seven patients with PAOD. Part 2 investigated the value of the optimum Levovist dosage in the assessment of 10 crural arteries in 10 consecutive patients with PAOD. Angiography was the reference standard. RESULTS Part 1: Levovist significantly enhanced color and spectral Doppler scan as compared with baseline ultrasound scan, but no differences were found between the Levovist dosages. Thus, the lowest Levovist dosage sufficed for application in part 2, because of its infusion volume and prolonged enhancement time. Part 2: The agreement between contrast-enhanced duplex scanning and angiography was moderate (kappa = 0.50; 95% confidence interval [CI], 0.03-0.97). Five (50%) of 10 crural arteries that could not adequately be visualized with routine duplex scanning could be visualized with contrast-enhanced duplex scanning. CONCLUSION Contrast-enhanced duplex scanning by means of continuous infusion of Levovist in patients with PAOD improves the ultrasound scan investigation of crural arteries in case routine duplex scanning is inconclusive and might reduce the need for angiography.
Collapse
Affiliation(s)
- Stephen B Coffi
- Unit of Vascular Surgery, Academic Medical Center, Amsterdam
| | | | | | | | | | | |
Collapse
|
15
|
Hofmann WJ, Walter J, Ugurluoglu A, Czerny M, Forstner R, Magometschnigg H. Preoperative high-frequency duplex scanning of potential pedal target vessels. J Vasc Surg 2004; 39:169-75. [PMID: 14718835 DOI: 10.1016/s0741-5214(03)01044-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this prospective study conducted at a tertiary referral center was to evaluate the efficacy of high-frequency duplex scanning in the preoperative evaluation of potential pedal target vessels. Material and methods The study population consisted of thirty-three consecutive diabetics suffering critical limb ischemia, with indications of infra-popliteal occlusive disease. Duplex ultrasound was performed by an angiologist unaware of any prior imaging procedures. The pedal vessels were divided into four segments. The inner diameter-, the grade of calcification (on a scale from 1-to-3), the maximal systolic velocity, and the resistance index ([V.max syst-V min syst]/V max syst), were assessed by using a 13-MHz probe, and the pedal target vessel best suited for surgery was identified. Results of duplex scanning were compared to (1) the results of selective digital subtraction angiography (DSA) and contrast-enhanced magnetic resonance angiography (CE-MRA) studies interpreted by two radiologists, (2) the site of distal anastomosis predicted by a vascular surgeon according to DSA and CE-MRA studies, (3) the definitive site of distal anastomosis, and (4) early postoperative results (patency at three months). RESULTS Duplex scanning depicted significantly more pedal vascular segments than selective DSA- (P =.004, McNemar test). Agreement in predicting the site of distal anastomosis expressed as kappa value as follows: duplex versus DSA/CE-MRA, kappa 0.71;-DSA/CE-MRA versus definitive anastomosis, kappa 0.67; -and duplex versus definitive anastomosis kappa 0.82. Two patients were excluded from surgery as all three imaging modalities failed to demonstrate a pedal target vessel. Two patients had exploratory dissection of a pedal vessel (according to CE-MRA findings) that turned out to be occluded (as predicted by duplex scanning). In one patient the operation had to be terminated due to lack of autologous bypass material. In 31 patients who underwent pedal artery bypass, the resistance index could not be correlated to the run-off as assessed by intra-operative angiography. CONCLUSIONS High-frequency duplex focusing on the vacular-morphology is a worthwhile diagnostic tool to evaluate-potential pedal target vessels and extremely helpful when contrast-related methods (selective DSA, CE-MRA) do not sufficiently depict the pedal vasculature.
Collapse
Affiliation(s)
- W J Hofmann
- Division of Vascular Surgery, St John's Hospital, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria.
| | | | | | | | | | | |
Collapse
|
16
|
Eiberg JP, Hansen MA, Jensen F, Rasmussen JBG, Schroeder TV. Ultrasound contrast-agent improves imaging of lower limb occlusive disease. Eur J Vasc Endovasc Surg 2003; 25:23-8. [PMID: 12525807 DOI: 10.1053/ejvs.2002.1796] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to evaluate if ultrasound contrast-agent infusion could improve duplex-ultrasound imaging of peripheral arterial disease (PAD) and increase the agreement with digital subtraction arteriography (DSA). DESIGN prospective and consecutive study. MATERIAL of 60 consecutive PAD patients, 15 were found to have an inconclusive duplex-ultrasound scan of the trifurcation and were included in the study. All 15 patients (53% male) were scheduled for DSA, all being candidates for vascular surgery due to claudication (n = 3, 20%), rest pain (n = 5, 33%) and tissue loss (n = 7, 47%). METHODS on the day before DSA, a duplex-ultrasound scan of the trifurcation was performed. If the duplex-ultrasound scan was found inconclusive, it was repeated during continuous ultrasound contrast-agent infusion. DSA was performed unaware of the duplex-ultrasound results and served as the gold standard. RESULTS after contrast-agent administration, the number of inconclusively diagnosed segments was significantly reduced by 26 (70%), from 37 to 11(p < 0.001). In 19 segments (73%) contrast-agent infusion changed the diagnosis in accordance with the DSA (p < 0.05). Values of sensitivity and positive predictive value were improved from 0.20 (0.04-0.62) to 0.47 (0.26-0.69) and 0.50 (0.10-0.91) to 0.80 (0.49-0.93), respectively. Specificity and negative predictive value were unchanged. Agreement between duplex-ultrasound and DSA were improved from poor (kappa = 0.18 (95% CI: 0-0.82)) to moderate (kappa = 0.45 (0.17-0.74)) (p = 0.44). CONCLUSION ultrasound contrast-agents improve the diagnostic ability of duplex-ultrasound when scanning difficult arterial segments in patients suffering from PAD.
Collapse
Affiliation(s)
- J P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | |
Collapse
|
17
|
Hofmann WJ, Forstner R, Kofler B, Binder K, Ugurluoglu A, Magometschnigg H. Pedal artery imaging--a comparison of selective digital subtraction angiography, contrast enhanced magnetic resonance angiography and duplex ultrasound. Eur J Vasc Endovasc Surg 2002; 24:287-92. [PMID: 12323169 DOI: 10.1053/ejvs.2002.1730] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to evaluate selective digital subtraction angiography (DSA), contrast-enhanced magnetic resonance angiography (CE-MRA) and duplex ultrasound (duplex) in preoperative pedal artery imaging. MATERIAL AND METHODS DSA, CE-MRA and duplex were studied prospectively in 37 patients suffering from critical leg ischaemia. Two radiologists independently reviewed both the CE-MRA and DSA images. The pedal vessels were scored on a scale from 0 to III (0=vessel not visualised, I=vessel faintly visualised, II=stenosis >50%, III=vessel without relevant stenosis). Duplex ultrasound was performed by an angiologist blind to both the DSA and MRA findings and the pedal arteries were scored 0-III according to their diameter. Each examiner named the pedal artery best suitable for bypass surgery. Agreement in artery assessment was expressed as kappa values. Patency of the bypass at 30 days was used as validation of the artery's suitability as the run-off vessel. RESULTS interobserver agreement for DSA (weighted Kappa 0.63, CI 0.53-0.73 and CE-MRA (weighted kappa 0.60, CI 0.5-0.7) was moderate to substantial. CE-MRA depicted significantly more vascular segments than DSA (p congruent with 0.0001).In the prediction of the distal outflow vessel duplex and CE-MRA proved to be superior to DSA. CONCLUSION because of the moderate inter-observer agreement it may be questionable to regard selective DSA as gold standard imaging procedure in preoperative pedal artery imaging. CE-MRA and duplex are very helpful in assessing the pedal artery morphology and should be used if selective DSA does not sufficiently depict the pedal vasculature.
Collapse
Affiliation(s)
- W J Hofmann
- Landesklinik für Gefässchirurgie, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria
| | | | | | | | | | | |
Collapse
|
18
|
Eiberg JP, Madycki G, Hansen MA, Christiansen S, Grønvall Rasmussen JB, Schroeder TV. Ultrasound imaging of infrainguinal arterial disease has a high interobserver agreement. Eur J Vasc Endovasc Surg 2002; 24:293-9. [PMID: 12323170 DOI: 10.1053/ejvs.2002.1724] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to evaluate and compare the operator dependency of duplex ultrasound and digital subtraction arteriography (DSA) in patients suffering from chronic lower limb ischaemia. DESIGN prospective and blinded validation study. MATERIAL twenty-six consecutive patients (13 male and 13 females) with severe claudication (n=6, 23%), rest pain (n=7, 27%) or tissue loss (n=13, 50%). METHODS two physicians independently performed a duplex scan of the lower limb from groin to foot (15 segments). Segments were classified as insignificantly (<50% stenosis) or significantly (>50% stenosis or occlusion) diseased. DSA was performed within 24h of the duplex scanning and was independently reported by two radiologists in the same manner. Interobserver agreement was assessed for both diagnostic methods. After 10 months the arteriograms were reassessed and the intraobserver agreement calculated. RESULTS for the limb as a whole the interobserver agreement was good and similar for both duplex and DSA, with kappa-values of 0.79 (95%-CI: 0.72-0.86) and 0.80 (0.74-0.87). In the femoral, crural and pedal segments the interobserver agreement was similar for both methods. The intraobserver agreement between the two DSA readings was 0.84 (0.79-0.90). CONCLUSION ultrasound is comparable to arteriography when visualising arterial occlusive disease in patients with chronic lower limb ischaemia.
Collapse
Affiliation(s)
- J P Eiberg
- Department of Vascular Surgery, Rigshospitalet 3111, Blegdamsvej 9, Dk-2100 Copenhagen Ø, Denmark
| | | | | | | | | | | |
Collapse
|