Can Lower Limb Ultrasonography Replace Arteriography?

London, N.J.M.; Sensier, Y.; Hartshorne, T.

doi:10.1177/1358863x9600100205

Cited by 19 publications

(4 citation statements)

References 29 publications

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“…Until recently, non‐invasive imaging options included arterial duplex ultrasound and magnetic resonance imaging [3]. Although widely available, arterial duplex ultrasound can be very operator dependent and significant limitations occur with obese patients and in heavily calcified arterial segments [4, 5]. Magnetic resonance angiography has a high diagnostic accuracy, but is costly and not widely available [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease

Shareghi

Gopal

Gul

et al. 2009

Cathet Cardio Intervent

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Background: Previous studies of multidetector CT (MDCT) of the lower extremities for the detection of peripheral vascular disease showed high diagnostic accuracy but were performed with older generation systems. Objective: The purpose of this study was to evaluate the diagnostic accuracy of 64 MDCT for the detection of hemodynamically significant disease within the lower extremity peripheral vasculature as compared to digital subtraction angiography (DSA). Methods: Twenty-eight consecutive patients with symptomatic lower extremity intermittent claudication and an abnormal anklebrachial index (ABI; less than 0.9) were evaluated by both 64 MDCT and DSA. Axial images were acquired with a 64 multidetector general electric light speed VCT scanner. Images were analyzed using a GE Advantage workstation (AW 4.3) capable of advanced image processing and manipulation. The aorto-iliac and lower extremity arteries were divided into 15 segments per limb (30 segments per patient). Eight hundred forty segments were analyzed in a blinded fashion by physicians with level III CT certification. Segments were classified as grade I (<10% stenosis), grade II (10-49%), grade III (50-99%), and grade IV (occlusion). Results: For all segments evaluated, the overall diagnostic accuracy for detecting grade III and IV lesions was 98% with a sensitivity of 99% and a specificity of 98%. For the aorto-iliac segments, the diagnostic accuracy was 98% with a sensitivity of 100% and a specificity of 99%. For the femoropopliteal segments, the overall accuracy was 98% with a sensitivity of 100% and a specificity of 99%. For the infra-popliteal segments, the overall accuracy was 98% with a sensitivity of 97% and a specificity of 99%. One segment could not be visualized by MDCT compared to 49 segments that could not be visualized by DSA. Conclusions: This study demonstrates excellent diagnostic accuracy of 64 MDCT in the detection of hemodynamically significant disease of the lower extremities. More segments are visualized using 64 MDCT than DSA, allowing more complete visualization of the vascular tree. CT angiography should be considered in the diagnostic evaluation of symptomatic patients with peripheral vascular disease. V C 2009 Wiley-Liss, Inc.

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Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease

Shareghi

Gopal

Gul

et al. 2009

Cathet Cardio Intervent

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“…The application of ultrasound in the assessment of peripheral arterial disease is an established technique that has been shown to provide comparable results to that of arteriography. 11,12 Furthermore, its utility in rapidly identifying vascular trauma within the ED setting has also been shown. [13][14][15] Radiology-performed ultrasound spares the patient the radiation exposure of CTA but is not available at all times in all EDs.…”

Section: Discussionmentioning

confidence: 99%

Point-of-care Ultrasound for the Evaluation of Acute Arterial Pathology in the Emergency Department: A Case Series

Drake

Dreyer

Hoffer

et al. 2022

Clinical Practice and Cases in Emergency Medicine

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Introduction: The use of point-of care ultrasound (POCUS) in the evaluation of vascular emergencies including abdominal aortic aneurysm and deep vein thrombosis is well established. However, no current guidelines exist to outline the use of POCUS in the management of acute peripheral arterial pathology. Case Series: Here, we present a case series that illustrates the utility of POCUS in the assessment of both traumatic and nontraumatic peripheral arterial disease. Direct visualization of the vasculature via B-mode, color Doppler, and pulsed-wave Doppler assisted in the diagnosis of the following: 1) an acute, post-catheterization thrombus of the proximal radial artery; 2) a complete, traumatic radial artery transection; 3) a forearm hematoma with active arterial extravasation; 4) a traumatic arteriovenous fistula; 5) an acute thrombosis of an artery bypass graft; and 6) an infected pseudoaneurysm. Conclusion: The incorporation of POCUS into patient care allowed for rapid identification of significant peripheral arterial pathology and led to changes in clinical management, expedited patient care, and circumvented potentially harmful complications.

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“…Hence, we find that DA is being investigated for this purpose. [1][2][3] Although some authors have demonstrated an acceptable correlation between arteriography and DA, [4][5][6][7][8][9][10][11][12] others have been less enthusiastic and continue to advocate preoperative or prebypass arteriography. [13][14][15][16] Some of the factors that may explain these discrepant results include:…”

Section: Duplex Arteriographymentioning

confidence: 99%

Duplex Arteriography for Lower Extremity Revascularization

Hingorani¹,

Ascher²,

Marks³

2007

Perspectives in Vascular Surgery and Endovascular Therapy

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Duplex arteriography may be a potential replacement of preoperative standard contrast arteriography for peripheral arterial imaging in lower extremity revascularization procedures. In patients with chronic or acute ischemia, a well-performed duplex arteriography offers several practical advantages over contrast arteriography: it is noninvasive; it does not require nephrotoxic agents; it is portable and can be done expeditiously; color flow and waveform analysis provide a better estimation of the hemodynamic significance of occlusive disease; it allows direct visualization of the entire artery and not only of the lumen thus enabling plaque characterization; with color flow and power Doppler techniques, it is possible to identify patent arteries subjected to very low flow states; and it can detect occluded arterial aneurysms thereby avoiding unnecessary attempts at thromboembolectomies. High-quality arterial ultrasonography performed by a highly skilled and well-trained vascular technologist may represent an alternative to conventional arteriography for patients in need of primary or secondary lower extremity revascularization.

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Can Lower Limb Ultrasonography Replace Arteriography?

Cited by 19 publications

References 29 publications

Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease

Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease

Point-of-care Ultrasound for the Evaluation of Acute Arterial Pathology in the Emergency Department: A Case Series

Duplex Arteriography for Lower Extremity Revascularization

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