title: Duplex ultrasound assessment of native stenoses in the superficial femoral and popliteal arteries: a comparative study examining the influence of multisegment lesions.
abstract: OBJECTIVE
  To evaluate duplex ultrasonography (DUS) in the assessment of femoropopliteal stenoses comparing a single native stenosis (SNS) to multisegmental native stenoses (MNS).
  
  
  METHODS
  Among the 1284 patients treated for atherosclerotic occlusive disease involving the femoropopliteal segment between November 2002 and November 2012, 139 patients (97 men; mean age 68±8 years) with 142 SNS or 143 MNS in 79 and 60 patients, respectively, were eligible for this retrospective analysis. The peak systolic velocity ratios with proximal (PSVRprox) and distal (PSVRdist) reference for the 285 lesions were compared with their respective angiographic stenosis grade as measured by 2 independent readers using quantitative vascular analysis to ensure objectivity. Receiver operating characteristic curve analysis was used to evaluate sensitivity, specificity, and the optimal thresholds of PSV and PSVR for detection of stenoses by grade (>50%, >70%, or >80% diameter stenosis). The area under the curve (AUC) values of dependent and independent receiver operating characteristic curves were compared.
  
  
  RESULTS
  For SNS, correlation of PSVRprox to diameter stenosis (R=0.88) was higher (p<0.001) than the correlation for MNS (R=0.78). In the SNS group, the AUC for detecting a >50% (0.99±0.01), >70% (0.98±0.01), and >80% (0.96±0.01) stenosis with PSVRprox was significantly higher than in the MNS group [AUC50% 0.93±0.02 (p=0.01), AUC70% 0.92±0.02 (p=0.02), and AUC80% 0.87±0.03 (p=0.003)]. The optimal thresholds for detecting >50%, >70%, and >80% stenoses for SNS using PSVRprox were 2.6, 3.3, and 3.9, respectively. For MNS, the optimal thresholds of PSVRprox were 2.6, 3.4, and 3.9, respectively, with respective sensitivities of 87%, 81%, and 75%; respective specificities of 93%, 90%, and 82%; negative predictive values of 45%, 64%, and 74%; and positive predictive values of 99%, 95%, and 83%.
  
  
  CONCLUSIONS
  DUS is an optimal tool for quantification of SNS. However, a multisegment setting has a significant negative impact on the quantification of femoropopliteal artery stenosis.
authors: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Richard-Roland
authors: RR
authors: Macharzina
authors: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Simon F
authors: SF
authors: Schmid
authors: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Ulrich
authors: U
authors: Beschorner
authors: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Elias
authors: E
authors: Noory
authors: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Aljoscha
authors: A
authors: Rastan
authors: Center for Medical Biometry and Medical Informatics, University Freiburg, Germany.
authors: Werner
authors: W
authors: Vach
authors: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Uwe
authors: U
authors: Schwarzwälder
authors: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Sebastian
authors: S
authors: Sixt
authors: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Karlheinz
authors: K
authors: Bürgelin
authors: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Franz-Josef
authors: FJ
authors: Neumann
authors: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany thomas.zeller@universitaets-herzzentrum.de.
authors: Thomas
authors: T
authors: Zeller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003251:Constriction, Pathologic; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D011150:Popliteal Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D011859:Radiography; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018615:Ultrasonography, Doppler, Color
keywords: angiography; duplex ultrasonography; peripheral occlusive disease; popliteal artery; proximal systolic velocity ratio; quantitative vessel analysis; stenosis; superficial femoral artery