title: Duplex scanning allows selective use of arteriography in the management of patients with severe lower leg arterial disease.
abstract: OBJECTIVE
  Until April 1997 we routinely performed intra-arterial digital subtraction angiography (iaDSA) in all patients with severe lower leg ischemia requiring intervention. After a comparative study of duplex scanning (DS), pulsegenerated runoff, and iaDSA of the lower leg arteries, we postulated that management could be based on DS/pulse-generated runoff in 59% of patients. We prospectively evaluated the safety of such a noninvasive workup strategy.
  
  
  METHODS
  All consecutive patients referred with severe lower leg ischemia between April 1997 and September 1998 were eligible. Management was based on DS with iaDSA being performed only on indication. Complications within 30 days and 12- and 24-month patency, survival, and limb salvage rates were recorded and compared with historical controls.
  
  
  RESULTS
  A total of 125 limbs in 114 patients were evaluated (74% rest pain or tissue loss). In 97 (78%) of 125 limbs, management was based on DS. It comprised conservative treatment (n = 33, 0% after iaDSA), percutaneous transluminal angioplasty (n = 25, 16% iaDSA), femoropopliteal bypass graft (n = 29, 17% iaDSA), femorotibial bypass graft (n = 29, 62% iaDSA), and other surgical procedures (n = 8, 4% iaDSA). Overall, the mortality within 30 days was 4% (5/114), and 2-year survival was 83%. Two-year primary and secondary patency and limb salvage rates were 75%, 93%, and 93% after a femoropopliteal bypass operation, respectively. One-year primary and secondary patency and limb salvage rates were 35%, 73%, and 74%, respectively, after a femorocrural bypass operation. There were no differences in patient characteristics, indication for specific treatment, and immediate and intermediate term outcome between the study and reference population.
  
  
  CONCLUSIONS
  In a vascular unit with wide expertise in DS of the lower leg arteries, management of patients with severe lower leg ischemia can be based on DS in most patients without negative effects on clinical outcome within 30 days and at 2-years' follow-up.
authors.affiliation: Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Koelemay
authors.forename: D A
authors.initials: DA
authors.lastname: Legemate
authors.forename: H
authors.initials: H
authors.lastname: de Vos
authors.forename: A J
authors.initials: AJ
authors.lastname: van Gurp
authors.forename: R
authors.initials: R
authors.lastname: Balm
authors.forename: J A
authors.initials: JA
authors.lastname: Reekers
authors.forename: M J
authors.initials: MJ
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000592:standards*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D007866:Leg / Q000098:blood supply*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012449:Safety; D016879:Salvage Therapy / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000592:standards*; D014654:Vascular Patency