A prospective comparison of lower limb colour-coded Duplex scanning with angiography

Department of Medical Physics, Leicester Royal Infirmary, UK.
European Journal of Vascular and Endovascular Surgery (Impact Factor: 2.49). 02/1996; 11(2):170-5. DOI: 10.1016/S1078-5884(96)80047-5
Source: PubMed


To compare the diagnostic value of colour Duplex scanning with arteriography for the detection of arterial disease of the aortoiliac arteries, femoropopliteal arteries and the origins of the tibial vessels.
Prospective, semi-blind study.
Vascular laboratory and radiology department, University Hospital.
A total of 1658 arterial segments in 148 limbs were studied both by colour Duplex scanning and digital subtraction arteriography. Individual arterial segments were classified on the basis of peak systolic velocity ratios < 2.0, > or = 2.0 or an absent Doppler signal, as 0-49%, 50-99% diameter reduced, or occluded. The same arterial segments were similarly classified on the basis of arteriography and the two modalities were compared using a Kappa (k) analysis.
The overall agreement between arteriography and colour-coded Duplex was kappa = 0.74 (95% CI, 0.70-0.78), this indicates substantial agreement. Kappa values (95% CI) from the aortoiliac, femoropopliteal and the origins of the infrapopliteal arteries were kappa = 0.59 (0.49-0.73; moderate agreement), kappa = 0.80 (0.76-0.84; substantial agreement) and kappa = 0.48 (0.35-0.61; moderate agreement) respectively.
We conclude that there is substantial agreement between colour-coded Duplex and arteriography of the lower limbs, and that the ability of colour-coded Duplex to plan and guide lower limb vascular interventions requires investigation.

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    • "Initially used for the assessment of aortoiliac and femoropopliteal arteries, duplex scanning has become a valuable tool for use in the infrapopliteal segment (Cossman et al. 1989; Hatsukami et al. 1992; Karacagil et al. 1996; Larch et al. 1997; Moneta et al. 1992; Sensier et al. 1996b). Visualization of the complete arterial tree of the lower limb from the aorta to the foot arteries is justified by improvements in vascular surgery procedures allowing bypass grafting to very small distal arteries. "
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    ABSTRACT: The purpose of this article is to review the performance of duplex ultrasound scanning in assessing lower limb arterial disease with emphasis on patients with multisegmental occlusive lesions. Several studies have reported that duplex scanning can be as accurate as angiography to localize arterial stenoses. In spite of these promising results, there still remain some difficulties and controversies. Among them, it has been reported that multisegmental disease may affect the accuracy of duplex scanning. Indeed, some studies have indicated a lower sensitivity for detecting significant stenoses distal to severe or total occlusions. It also was demonstrated that second-order stenoses were detected with lower sensitivity compared to first-order stenoses. The main reason proposed to explain this lower sensitivity is that the highly reduced flow distal to occluded or highly stenotic segments increases the difficulty of detecting significant Doppler velocity changes in the distal or secondary stenoses. The intrinsic limitations of the peak systolic velocity ratio used as a classification criterion are presented. Finally, new and promising developments in power Doppler imaging and ultrasound contrast agents are discussed, because they may allow expansion of the capabilities of current ultrasound scanning systems and provide more accurate diagnosis of patients with multiple disease.
    Preview · Article · Jun 1999 · Ultrasound in Medicine & Biology
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