title: The impact of a focused vascular lower limb arterial duplex (F-VLAD) scan in management decisions for acute limb ischaemia.
abstract: OBJECTIVE
  To establish the diagnostic accuracy of a 'focused vascular lower limb arterial duplex scan (F-VLAD)' developed to facilitate rapid decision-making for acute limb ischaemia (ALI).
  
  
  METHODS
  Ten cases of ALI were identified from our patient database; clinical details, history and examination findings were extracted from the clinical notes. Original 'full' duplex ultrasound (DUS) pictorial reports were 're-formatted' to include only anatomical segments included in the 'F-VLAD' scan. The series of 10 reports were emailed to 1741 vascular surgeons. Each recipient received a random mixture of full and F-VLAD scans. Participants were asked regarding next step in management and confidence in decision-making (Likert scale; 1 strongly disagree, 5 strongly agree). The cases were again sent out to the same database and respondents were asked as to the cause of ischaemia (embolic or thrombosis).
  
  
  RESULTS
  Eighty-one participants responded to the first survey and 43 participants to the second survey. Participants felt more confident making decisions regarding management using the full duplex report compared to the F-VLAD report (4 (3-4) vs 3 (2-4), median (IQR); p<0.001). However, there was no significant difference in diagnostic accuracy (differentiating embolus from thrombosis) when comparing the F-VLAD and full DUS reports (85.4% vs 88.3%; p=0.461). F-VLAD and 'full' DUS reports had comparable sensitivity (85.1% vs 86.8%), specificity (85.6% vs 89.2%),positive predictive value (PPV) (80.4% vs 81.9%) and negative predictive value (NPV) (89.2% vs 92.2%), respectively.
  
  
  CONCLUSIONS
  The F-VLAD scan has comparable accuracy to a traditional full DUS in diagnosing the underlying aetiology of ALI. This may facilitate surgeon-performed point-of-care DUS.
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
authors.forename: Pasha
authors.initials: P
authors.lastname: Normahani
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aslam
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Standfield
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
authors.forename: Usman
authors.initials: U
authors.lastname: Jaffer
mesh_terms: D001158:Arteries / Q000473:pathology; D000066491:Clinical Decision-Making; D004617:Embolism / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D011237:Predictive Value of Tests; D013927:Thrombosis / Q000000981:diagnostic imaging; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*
keywords: POCUS; abbreviated; duplex; ischaemia; ultrasound; vascular