Comparative Evaluation of Color Doppler and Conventional Digital Subtraction Angiography in Infra Genicular Arterial Disease: A Prospective Comparative Study

Abstract

Patient suffering from infragenicular peripheral arterial occlusive disease is not an uncommon clinical scenario. In our setup Buergers Disease and Atherosclerotic disease are the most common cause of arterial insufficiency, particularly in middle aged smokers of low socioeconomic status apart from vasculitis, thromboembolism and trauma. Color Doppler (CD) is a good modality for assessment of supragenicular arterial system, however infragenicular arteries are many times cannot be examined properly because of their deeper position. Digital Subtraction Arteriography (DSA) is a better modality in this situation. The aim of this study is to compare color doppler and conventionional digital subtraction arteriography in patients of infragenicular arterial disease. This prospective study was designed in the department of Radiodiagnosis G.R. Medical College Gwalior Madhya-Pradesh, India.50 patients of lower limb ischemia formed the subjects and their affected lower limbs were evaluated by CD (COLOR DOPPLER) and DSA (Digital Subtraction Arteriography), for localization and grading of lesions in the arteries, into normal, insignificant stenosis, significant stenosis and occlusion. The results were analyzed in a blind fashion in a total of 150 vascular segments. Results were analyzed by two way contingency tables and kappa statistics. In our study we observed that in the infragenicular arterial system disease, color doppler had a Sensitivity = 83%, Specificity = 92%, PPV = 66%, NPV = 96% Therefore it can be concluded that a normal color flow and spectral waveform in Color Doppler examination of inferiorgenicular arteries excludes the need of arteriography. However DSA is definitely helpful in patient where abnormal/absent color flow and/or spectral wave form is seen because of lower PPV (66%) Color Doppler.