title: Duplex ultrasonography arteriography as first-line investigation for peripheral vascular disease.
abstract: BACKGROUND
  The gold standard for evaluation of the lower extremity arterial tree is catheter angiography. Duplex arterial-occlusive imaging or duplex ultrasonography arteriography, a noninvasive technique, is used as the first-line investigation in patients with peripheral vascular disease at our centre. Based on the results of duplex imaging, patients who require angiographic intervention then proceed with simultaneous catheter arteriography and intervention. This study aimed to compare the results of duplex imaging alone as the first-line investigation against the eventual results of catheter angiography, and to assess the impact of the former on patients' clinical outcomes.
  
  
  METHODS
  All cases involving patients who underwent duplex imaging followed by angiographic intervention, from May 2008 to February 2009, were discussed at weekly interdisciplinary meetings. Only patients who underwent lower limb imaging were included in the study. Those who were involved in grafts and stent surveillance studies, as well as those with incomplete duplex images were excluded.
  
  
  RESULTS
  During the study period, 113 duplex imaging studies of the lower limb followed by percutaneous transluminal angioplasty were performed at our hospital for peripheral vascular disease. The iliac artery was visualised in 40 images, but could not be visualised in 73 images. There was a potential change in management in three cases due to radiological differences between the duplex images and angiography films.
  
  
  CONCLUSIONS
  In our series, duplex imaging was found to be accurate enough to guide initial clinical management of patients with peripheral vascular disease. This modality is the preferred first-line investigation for such patients at our centre.
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore 169608. wong.th@doctors.org.uk
authors.forename: Ting Hway
authors.initials: TH
authors.lastname: Wong
authors.forename: Kiang Hiong
authors.initials: KH
authors.lastname: Tay
authors.forename: Mathew G
authors.initials: MG
authors.lastname: Sebastian
authors.forename: Seck Guan
authors.initials: SG
authors.lastname: Tan
mesh_terms: D000792:Angiography / Q000379:methods*; D017130:Angioplasty / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000000981:diagnostic imaging*; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods*; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*