Duplex Arteriography for Lower Extremity Revascularization

Abstract

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.

Treatment planning for peripheral arterial disease based on duplex ultrasonography and computed tomography angiography: Consistency, confidence and the value of additional imaging

“…Based on prior publications, our findings might even underestimate the potential of DUS for treatment planning, and the value of additional imaging might even be of less than found in this study. 3,12,[25][26][27] The variability in treatment planning and scoring behavior of reviewers is an important limitation of this study. This variability might partially be the result of our multinational study design and the fact that one reviewer's decisions were based on consensus, whereas others decided individually.…”

“…As in many other publications in this field, we highlight the need for internal validation of technicians, clinicians, and a close relationship between these 2 before adopting a workup with DUS only, because the utility of DUS is known to be dependent on the skills of technicians and confidence and trust of clinicians. 3 Future directions and recommendations. While recognizing variability between centers and clinicians, this study identified the obstacle of clinician confidence as a factor that could hamper greater use of DUS in the appropriate clinical settings.…”

“…Angiography has long been the conventional imaging modality, but this technique is invasive and requires arterial puncture, intravascular administration of contrast, and radiation exposure and is furthermore associated with local and systemic complications with the resulting additional care needed. [1][2][3] In an increasing number of European institutions, angiography has been replaced by less invasive imaging techniques, such as Duplex ultrasonography (DUS), computed tomography angiography (CTA), or magnetic resonance angiography. 4,5 DUS is the least expensive, and the only modality that does not require contrast or radiation exposure, as do angiography, CTA, and magnetic resonance angiography.…”

“…[9][10][11][12][13] More recent publications advocate for an imaging work up with DUS only for PAD patients, because DUS has been shown to be a reliable tool for treatment planning. 3,4,14,15 Nonetheless, the use of DUS is low in the United States, 16 and routine use of DUS as the sole imaging modality before intervention has, with the exception of some centers, 3,15 not been accepted widely.…”

The Vascular Laboratory: A Proven Necessity for Optimal Vascular Disease Management but Rare in Developing Countries

“…9,10 For example, in many vascular centers, carotid endarterectomy, and lower-extremity arterial bypass is planned on the basis of duplex scanning alone, in most of their patients. 11,12 Duplex scanning has become the standard test for the evaluation of patients with suspected deep vein thrombosis. Decisions regarding anticoagulation therapy are typically made without resorting to invasive contrast studies such as venography.…”