The additional value of angiography after colour-coded duplex on decision making in patients with critical limb ischaemia. A prospective study.
OBJECTIVE
to investigate prospectively the additional value of intra arterial digital subtraction arteriography (IADSA) for decision making in patients with critical limb ischemia (CLI). Treatment plans based on colour-duplex imaging (CDI) were compared with treatment plans based on IADSA.


METHODS
ninety-eight consecutive patients with 112 legs with CLI were investigated by CDI and IADSA. Treatment plans based on CDI and IADSA were made separately during a multidisciplinary meeting. Both plans were retrospectively analysed with the outcome of the operation or the endovascular procedure as a reference.


RESULTS
eighty-eight patients with 101 legs could be analysed. In 91 out of the 101 legs (90%) CDI offered the same strategy as the IADSA. In 10 legs IADSA provided additional information. Most of the additional information concerned the crural vessels.


CONCLUSIONS
the preoperative planning of treatment in patients with chronic critical ischaemia of the lower limbs can be based on CDI alone in most patients. For planning crural revascularisation additional information may be needed. If severe calcification prevents adequate visualisation of the crural vessels or no patent anterior or posterior tibial artery with outflow across the ankle is present, IADSA should be performed.
Avenarius
J K A
JK
Department of Radiology, St. Elisabeth Hospital, 5000 LC Tilburg, The Netherlands.
Breek
J C
JC
Lampmann
L E H
LE
van Berge Henegouwen
D P
DP
Hamming
J F
JF
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000792:Angiography / Q000592:standards*; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D003422:Critical Care; D003657:Decision Making; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007511:Ischemia / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency / Q000502:physiology