Echocardiographic evaluation of aorto-iliac occlusive disease

Abstract

Several studies demonstrated feasibility of visual assessment of the common femoral artery Doppler waveform, in an indirect evaluation of aorto-iliac segment stenosis. Patients with cardiac diseases referred for echocardiography often have coexistent arterial pathology. Since many of them are potential candidates for endovascular procedures, we decided to study, whether echocardiography can be useful for detection of aorto-iliac occlusive disease. We evaluated 92 patients with abdominal aortic aneurysm or peripheral artery occlusive disease, referred from the vascular surgery department for cardiac evaluation before surgery. At the end of an echocardiographic examination, evaluation of flow in the distal external iliac arteries with an echocardiographic probe was performed. The Doppler waveform was classified into normal—with early diastolic flow reversal or abnormal—without early diastolic flow reversal. Echocardiographic results were compared in a blinded fashion with reports from computed tomography angiography. Overall there were 58 iliac segments with significant (≥70%) area stenosis or occlusion and 126 iliac segments without significant disease on computed tomography angiography. Abnormal Doppler waveform was found in 56 out of 58 abnormal iliac segments—sensitivity 97%, and normal waveform was found in 106 out of 126 normal iliac segments—specificity 84%. Positive predictive value of abnormal Doppler waveform for significant iliac disease was 74%, and negative predicting value was 98%. Detection of significant stenoses in aorto-iliac segments is feasible with echocardiography. Further studies are necessary to evaluate its potential utility in a population of patients with cardiac disease referred for echocardiographic study.

Echocardiographic Evaluation of External Iliac Artery Doppler Waveform in Patients with Coronary Artery Disease

“…The measurement of ABI ≤ 0.9 was shown to be highly specific for the presence of significant arterial stenosis in studies using digital subtraction angiography or magnetic resonance angiography as the reference method . Although, in our study, no arterial imaging reference was available, results of previous studies suggest that the abnormal distal EIA Doppler waveform corresponds to the presence of the significant aortoiliac, common femoral, or proximal superficial femoral stenosis …”

“…Thus, evaluation of PAOD, as an extension of a routine echocardiographic study, if feasible, could provide clinically important information. Recently, we demonstrated considerable good diagnostic value of echocardiographic evaluation of aortoiliac occlusive disease by visual interpretation of the distal external iliac artery (EIA) Doppler waveform in surgical patients with lower limb ischemia or/and abdominal aortic aneurysm . In this study, we decided to check the utility of this assessment in patients with CAD – one of the major group of patients evaluated in echocardiographic laboratory.…”