Can cruropedal colour duplex scanning and pulse generated run-off replace angiography in candidates for distal bypass surgery.
OBJECTIVE
To compare the diagnostic accuracy of duplex scanning (DS) and pulse generated run-off (PGR) with ia-DSA for the assessment of cruropedal outflow and explore the reliability of clinical decision making based on a work-up with DS/PGR in candidates for peripheral bypass surgery.


METHODS
Popliteal, crural and pedal arteries were evaluated independently with DS and ia-DSA in 126 limbs of 120 consecutive patients for claudication (16%) or critical ischaemia (84%). Arterial segments were graded with DS and ia-DSA as normal, stenosed, or occluded and compared using weighted kappa (kappa) analysis. PGR was used to select the best crural artery for bypass. Proposed management based on DS/PGR and, if applicable, anastomosis site were compared to definitive treatment based on ia-DSA.


RESULTS
Overall agreement between DS and ia-DSA for popliteal and crural arteries was moderate (kappa 0.51, 95% CI 0.48-0.55) with good agreement within the popliteal (kappa 0.67) and anterior tibial (kappa 0.61) arteries. Agreement was moderate within the pedal arterieds (kappa 0.32, 95% CI 0.24-0.40). In 74/126 (59%) limbs proposed management with DS/PGR was identical to ia-DSA. In 23/29 (79%) femoropopliteal and 15/37 (41%) femorocrural bypasses DS/PGR agreed perfectly with ia-DSA with regard to acceptor artery and anastomosis site.


CONCLUSIONS
DS can accurately assess the popliteal and anterior tibial arteries. In a substantial number of patients with severe lower limb ischaemia decisions for conservative management, PTA and femoropopliteal bypass can be based on a DS/PGR work-up.
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
M J
MJ
Koelemay
D A
DA
Legemate
H
H
de Vos
J A
JA
van Gurp
J A
JA
Reekers
M J
MJ
Jacobs
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D019917:Blood Vessel Prosthesis Implantation; D005069:Evaluation Studies as Topic; D005260:Female; D005528:Foot / Q000098:blood supply; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging* / Q000601:surgery; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011674:Pulse; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color