The additional value of intraoperative angiography in infragenicular reconstruction.
OBJECTIVE
To evaluate the ability of preoperative intraarterial digital subtraction angiography (IADSA) to predict the feasibility of infragenicular reconstruction and site of the distal anastomosis.


METHODS
Prospective study.


METHODS
University Hospital


METHODS
45 patients with 50 ischaemic limbs, considered potential candidates for infragenicular reconstruction.


METHODS
Pre-reconstruction intraoperative angiography (IOA) was used as the gold standard. Analysis of angiograms was performed blindly and independently by a single observer. In patients who ultimately underwent primary amputation, exploration and attempted angiography of the crural and ankle vessels was performed to verify the IADSA findings.


RESULTS
There was 87% accuracy (kappa = 0.66) between IADSA and IOA in differentiating between a normal, stenosed and occluded tibial artery and there was 86% accuracy (kappa = 0.67) in determining the adequacy of run-off into the pedal arch. IADSA had a positive predictive value of 100% to determine the feasibility of reconstruction but a negative predictive value of only 73%. After excluding those patients tha IADSA deemed non-reconstructable, IADSA had a positive predictive value of 97% to determine the correct artery and 92% to determine the correct segment of artery for distal anastomosis.


CONCLUSIONS
IADSA could not determine when reconstruction was not possible, but in those deemed reconstructable by IADSA, the surgeon can confidently expose the appropriate artery at the appropriate level knowing the pedal run-off status in 86% of patients. IADSA should not be used to exclude reconstruction (i.e. pre-reconstruction IOA is still required in these patients) but for the remainder, IADSA can be used to plan surgical strategy without recourse to IOA.
Sayers
R D
RD
Department of Vascular Surgery, Leicester General Hospital, U.K.
Naylor
A R
AR
London
N J
NJ
Watkin
E M
EM
Macpherson
D S
DS
Barrie
W W
WW
D000671:Amputation, Surgical; D000714:Anastomosis, Surgical; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D005240:Feasibility Studies; D005360:Fibula / Q000098:blood supply; D005528:Foot / Q000098:blood supply; D005544:Forecasting; D006801:Humans; D007430:Intraoperative Care; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D011150:Popliteal Artery / Q000601:surgery; D011446:Prospective Studies; D015641:Radiography, Interventional; D012039:Regional Blood Flow; D016037:Single-Blind Method; D016909:Tibial Arteries / Q000601:surgery