Duplex assessment of run-off before femorocrural reconstruction

Wilson, Y.G.; George, J. K.; Wilkins, David G.; Ashley, S.

doi:10.1111/j.1365-2168.1997.00595.x

Cited by 22 publications

(18 citation statements)

References 22 publications

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“…11). A technically adequate examination was reported to be feasible in 80±100 % of cases, taking into account that careful exploration of distal vessels is a time-consuming investigation (from 10 to 90 min) [10,11,41,43,46,47,48,49,50,51,52]. Caster et al reported a success rate of 94, 96 and 83 % for the anterior tibial, posterior tibial and peroneal arteries, respectively [48].…”

Section: Accuracy Of Colour Doppler In the Detection Of Stenoses And mentioning

confidence: 99%

“…Doppler criteria included velocity measurements and colour images evaluating anatomical features such as calibre, calcifications and continuity with pedal arch. Whereas angiography selected the best suitable runoff vessels in 32 cases, colour Doppler sonography proved to be correct in all patients at surgical intervention[61]. In 1998 Ligush et al[16] reported equivalent results for Doppler imaging and angiography to guide infrainguinal reconstructions in 36 patients with critical ischaemia.…”

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confidence: 95%

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Colour Doppler sonography of limb arteries

Rabbia

2001

Eur Radiol

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Section: Accuracy Of Colour Doppler In the Detection Of Stenoses And mentioning

confidence: 99%

mentioning

confidence: 95%

Colour Doppler sonography of limb arteries

Rabbia

2001

Eur Radiol

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“…50 For these preoperative examinations, flow and velocities are often very low indeed. High-frequency transducers are required using low colour and spectral pulse repetition settings.…”

Section: Aorto-iliac and Femoropopliteal Segmentsmentioning

confidence: 99%

Peripheral arteries

Deane¹,

Goss²

2011

Clinical Ultrasound

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“…Some centers have reported excellent results with preoperative duplex ultrasonography either as a stand-alone imaging modality 52,53 or as an adjunct to contrast arteriography, in which duplex imaging can identify areas of significant stenosis limiting the contrast arteriogram to a specific area requiring treatment. In our practice, we prefer DSA in these patients using strategies to limit contrast exposure including the use of nonionic iso-osmolar contrast diluted to 50% strength, using CO 2 for proximal arteries or avoiding aortoiliac imaging altogether.…”

mentioning

confidence: 97%

Arterial imaging in patients with lower extremity ischemia and diabetes mellitus

Pomposelli

2010

Journal of Vascular Surgery

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Precise, comprehensive imaging of the arterial circulation is the cornerstone of successful revascularization of the ischemic extremity in patients with diabetes mellitus. Arterial imaging is challenging in these patients because the disease is often multisegmental with a predilection for the distal tibial and peroneal arteries. Occlusive lesions and the arterial wall itself are often calcified and patients presenting with ischemic complications frequently have underlying renal insufficiency. Intra-arterial digital subtraction angiography (DSA), contrast enhanced magnetic resonance angiography (MRA), and more recently, computerized tomographic angiography (CTA) have been used as imaging modalities in lower extremity ischemia. Each has specific advantages and shortcomings in this patient population, which will be summarized and contrasted in this review. DSA is an invasive technique most often performed from a femoral arterial puncture and requires the injection of arterial contrast, which can occasionally cause allergic reactions. In patients with pre-existing renal insufficiency, contrast infusion can result in worsening renal failure; although usually self-limited, it may occasionally require hemodialysis, especially in patients with diabetes. However, DSA provides the highest degree of spatial resolution and image quality. It is also the only modality in which the diagnosis and treatment of arterial disease can be performed simultaneously. MRA is noninvasive, and when enhanced with gadolinium contrast injection provides arterial images of comparable quality to DSA and in some circumstances may uncover distal arterial targets not visualized on DSA. However, spatial resolution is inferior to DSA and erroneous interpretations due to acquisition artifacts are common. Specialized equipment and imaging techniques are necessary to minimize their occurrence in the distal lower extremity. In addition, due to the risk of inducing nephrogenic systemic fibrosis, gadolinium-enhanced MRA cannot be used in patients with renal insufficiency. CTA is noninvasive and rapidly performed, with better spatial resolution than MRA, but requires the largest volume of contrast infusion, exposes patients to high-doses of radiation, and is subject to interpretive error due to reconstruction artifacts especially in heavily calcified arteries, limiting its usefulness in many patients with diabetes. For patients in whom the planned intervention is a surgical bypass, DSA and MRA will provide high quality images of the lower extremity arterial anatomy. For patients in whom a catheter-based intervention is the likely treatment, a diagnostic DSA immediately followed by a catheter-based treatment in the same procedure is the preferred approach. In patients with pre-existing renal dysfunction, in which gadolinium-enhanced MRA is contraindicated, DSA or CTA can be performed. However, patients should have an infusion of intravenous normal saline solution or sodium bicarbonate before the procedure to reduce the incidence of contrast-induced nephropathy.

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Duplex assessment of run-off before femorocrural reconstruction

Abstract: Duplex imaging is superior to arteriography for preoperative assessment of distal run-off for femorocrural reconstruction.

Cited by 22 publications

References 22 publications

Colour Doppler sonography of limb arteries

Colour Doppler sonography of limb arteries

Peripheral arteries

Arterial imaging in patients with lower extremity ischemia and diabetes mellitus

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