A comparison of colour duplex ultrasonography, papaverine testing and common femoral Doppler waveform analysis for assessment of the aortoiliac arteries.
OBJECTIVE
to study the "accuracy" of aortoiliac colour duplex ultrasonography.


METHODS
prospective study.


METHODS
vascular laboratory, University Hospital.


METHODS
a total of 25 aortoiliac stenoses were studied in 23 patients. For each iliac segment, colour duplex ultrasound, papaverine testing, hyperaemic common femoral Doppler waveform analysis and hyperaemic testing using a thigh pressure cuff were performed. A velocity ratio of two was used to indicate a significant 50% diameter-reducing stenosis, but the velocity differences across stenoses as well as various characteristics of the hyyperaemic common femoral waveform were also studied. Retrospective receiver-operator characteristics and Kappa values were used for analysis.


RESULTS
the Kappa agreement between ultrasonography and papaverine testing was 0.12 using peak systolic velocity ratios and 0.8 using hyperaemic peak systolic velocity differences. Hyperaemic common femoral pulsatility (PI) and resistance index (RI) both gained a Kappa level of 0.60. The reactive hyperaemia produced by a thigh cuff was more pronounced than that produced by papaverine.


CONCLUSIONS
although the velocity ratio did not appear to perform well against the papaverine test, its apparent over-sensitivity calls into question the sensitivity of papaverine testing itself. The hyperaemic velocity difference at the stenosis or the hyperaemic PI or RI at common femoral level appear useful, non-invasive indicators of significant aortoiliac arterial disease.
Sensier
Y J
YJ
Department of Medical Physics, Leicester Royal Infirmary, Leicester, U.K.
Thrush
A J
AJ
Loftus
I
I
Evans
D H
DH
London
N J
NJ
D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging; D007083:Iliac Artery / Q000000981:diagnostic imaging*; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010208:Papaverine; D012372:ROC Curve; D012189:Retrospective Studies; D013599:Systole / Q000502:physiology; D018615:Ultrasonography, Doppler, Color; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D010208:Papaverine