title: Blinded comparison of preoperative duplex ultrasound scanning and contrast arteriography for planning revascularization at the level of the tibia.
abstract: OBJECTIVE
  We examined whether preoperative duplex ultrasound scanning (DU) could replace contrast material-enhanced arteriography (CA) in selecting the recipient artery of tibial or peroneal artery bypass grafts.
  
  
  METHODS
  In patients who underwent tibial or peroneal artery bypass grafting because of critical ischemia, images were obtained of the lower extremity arterial circulation with both DU and CA. Vascular surgeons, blinded to the operation performed, reviewed either DU or CA images for arterial visualization and patency. The tibial or peroneal artery best suited to receive the bypass graft was selected by surgeons using only data from either DU or CA images. This selection was compared with the artery actually used at bypass surgery.
  
  
  RESULTS
  Preoperative DU and CA data for 40 lower extremities in 38 patients undergoing bypass grafting at the level of the tibia provided 110 arteries: 38 anterior tibial arteries, 32 peroneal arteries, and 40 posterior tibial arteries. Ten arteries (8 peroneal, 2 anterior tibial) were not identified with DU, and 1 artery (anterior tibial) was not identified with CA. DU enabled prediction of the artery actually used in 88% of patients (35 of 40), whereas CA enabled prediction of the artery actually used in 93% of patients (37 of 40; P =.59). Duplicate findings at DU and CA enabled selection of 85% of arteries actually used (95% confidence interval, 71%-93%). Arteries used for bypass grafting had significantly higher peak systolic velocity (35 cm/s vs 25 cm/s; P =.04), higher end-diastolic velocity (15 cm/s vs 9 cm/s; P =.005), and greater diameter (2.4 mm vs 1.7 mm; P =.003) compared with arteries not selected for bypass grafting.
  
  
  CONCLUSIONS
  Findings at DU and CA typically agree when used to select tibial or peroneal arteries for bypass grafting. With DU there is occasional difficulty in identification of the peroneal artery, but selection of the actual artery used is accurate. Peak systolic velocity, end-diastolic velocity, and diameter characteristics correlate with arteriographic criteria for tibial bypass target artery selection. If DU enables adequate identification of a target artery for bypass grafting, and especially if the peroneal artery is seen, findings at CA are not likely to alter bypass execution.
authors.affiliation: Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Grassbaugh
authors.forename: Peter R
authors.initials: PR
authors.lastname: Nelson
authors.forename: Eva M
authors.initials: EM
authors.lastname: Rzucidlo
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
authors.forename: Mark F
authors.initials: MF
authors.lastname: Fillinger
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Powell
authors.forename: Robert M
authors.initials: RM
authors.lastname: Zwolak
authors.forename: Jack L
authors.initials: JL
authors.lastname: Cronenwett
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016037:Single-Blind Method; D016909:Tibial Arteries / Q000000981:diagnostic imaging* / Q000601:surgery; D018616:Ultrasonography, Doppler, Duplex