Eur J Vasc Endovasc Surg 11, 170-175 (1996)
A Prospective Comparison of Lower Limb Colour-coded Duplex
Scanning with Arteriography
Y. Sensier 1, T. Hartshorne 1, A. Thrush~,S. Nydahl 2, A. Bolia 3 and N.J.M. London 2
Departments of 1Medical Physics, 2Vascular Surgery and SRadiology, Clinical Sciences Building, Leicester Royal
Infirmary, Leicester, LE2 7LX, U.K.
Objective: 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.
Design. Prospective, semi-blind study.
Setting.. Vascular laboratory and radiology department, University Hospital.
Methods: 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,
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.
Results" The overall agreement between arteriography and colour-coded Duplex was k = 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 k = 0.59 (0.49-0.73; moderate agreement), k = 0.80 (0.76-0.84; substantial agreement) and
k = 0.48 (0.35-0.61; moderate agreement) respectively.
Conclusion: 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
Key Words: Duplex scanning; Doppler; Arterial disease; Angiography.
Although intra-arterial angiography of the lower
limbs is associated with minimal morbidity, it is
expensive, invasive, requires at least day case hospital
admission and provides only anatomical information.
Conversely, Duplex ultrasound is relatively inex-
pensive, non-invasive, can be performed on an out-
patient basis and provides both haemodynamic and
anatomical information. Whilst conventional Duplex
scanning of the lower limbs is time consuming, the
introduction of colour-coded Doppler ultrasound has
enabled real-time Doppler information to be dis-
played, allowing the rapid identification of haemody-
namic abnormalities. In view of the potential advan-
tages of colour-coded Doppler ultrasound over
arteriograph~ the purpose of this study was to
prospectively compare the two techniques in a consec-
Please address all correspondence to: Mr NJM London, Department
of Surger~ Clinical Sciences Building, Leicester Royal Infirmary,
Leicester LE2 7LX, U.K.
Patients awaiting diagnostic arteriography underwent
colour-coded Duplex examinations of the distal infra-
renal aorta, the iliac arteries and the arteries of the
lower limbs. The arterial system was classified into the
following 13 segments: distal aorta, common iliac,
external iliac, common femoral, profunda, proximal,
mid and distal superficial femoral, popliteal, anterior
tibial origin, tibioperoneal trunk, posterior tibial and
peroneal artery origins. For Duplex and arteriography
each arterial segment was categorised as <50%
stenosed, ~ 50% stenosed or occluded. In the case of
Duplex this classification was based on the result of
peak systolic velocity ratios whilst in the case of
utive series of patients with lower limb arterial
Material and Methods
Patients, study design and data analysis
1078-5884/96/020170 + 06 $12.00/0 © 1996 W. B. Saunders Company Ltd.
Lower Limb Scanning 175
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Accepted 1 June 1995
Eur J Vasc Endovasc Surg Vol 11, February 1996