Can a peripheral artery be used to detect venous to arterial circulation shunts?
BACKGROUND
Transcranial Doppler is a sensitive test for patent foramen ovale (PFO), but an absent temporal window precludes this in 12-15% of patients. We investigated whether the brachial (BrA), common carotid (CCA) or common femoral (CFA) artery provided reliable alternatives.


METHODS
Patients underwent simultaneous insonation of a middle cerebral artery (MCA, n = 66) and either (a) the BrA (n = 22), (b) CCA (n = 20) or (c) CFA (n = 24) with a 2-MHz transcranial Doppler probe.


RESULTS
The correlation between microbubble emboli counts in the MCA and the peripheral arteries was (a) r = 0.67 (95% CI 0.53-0.77) for the BrA, (b) r = 0.80 (95% CI 0.71-0.87) for the CCA and (c) r = 0.92 (95% CI 0.89-0.95) for the CFA. The agreement for detection of PFO was best using the CFA with a kappa of 0.95 (95% CI 0.66-1.0).


CONCLUSIONS
The CFA is a simple and reliable alternative to the MCA, but the criteria for diagnosis of a PFO are different.
Daly
Kevin J
KJ
Department of Vascular Surgery, South Manchester University Hospital, Manchester, UK. kjdaly@ukonline.co.uk
Hutchinson
Suzanne
S
McCollum
Charles N
CN
D001916:Brachial Artery; D017536:Carotid Artery, Common; D004618:Embolism, Air; D005263:Femoral Artery; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D045423:Microbubbles; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D020521:Stroke / Q000209:etiology; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*