Improved patient selection for angioplasty utilizing color Doppler imaging

Reliability of common femoral artery hemodynamics in assessing the severity of aortoiliac inflow disease

“…Arteriography is the diagnostic test of choice for evaluating aortoiliac occlusive disease before lower extremity revascularization, because it defines the degree and extent of the diseased arterial segments and aids in selecting the most appropriate intervention for correcting inflow disease. [1][2][3][4] However, this diagnostic method is invasive and expensive, and is associated with local and systemic complications in 4% to 9% of patients. [5][6][7] Color duplex ultrasound (CDU) scanning is a noninvasive and cost-effective diagnostic method [8][9][10] that is considered by many as the definitive preoperative mapping tool before carotid intervention.…”

“…[11][12][13][14][15][16] The utility of CDU scanning, however, as the sole preoperative mapping study 10,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] for aortoiliac occlusive disease in need of intervention remains under scrutiny. 2,[31][32][33][34][35] Moreover, with increasing availability of intraoperative high-resolution digital fluoroscopy, a paradigm shift in vascular intervention has evolved in which strategic or selective intraoperative arteriography is performed concomitant with the desired intervention, whether catheter-directed, endarterectomy, or bypass grafting. This one-step management approach requires a reliable noninvasive tool that allows for accurate prediction of the nature and location of suspected diseased segments.…”

Vascular Imaging before, during, and after Endovascular Repair

“…Duplex scanning is an accepted method for evaluating lower extremity arterial disease when selecting patients for possible interventional catheter-based procedures. Color Doppler imaging is frequently used to screen patients with claudication, limiting angiography to those who would benefit from an endovascular or surgical intervention [1]. Duplex scanning is used to evaluate traumatic injuries, assess the outcome of arterial reconstructions, and monitor recurrent or progressive lesions.…”

Can Lower Limb Ultrasonography Replace Arteriography?

“…Although clinical studies of lower limb duplex have used PSV ratios of either~2.0 (refs [16][17][18][19]23),~2.5 (refs 15,20,24,25) or~3.0 (ref. 26) to identify significant (>50% diameter reducing) stenoses, very few ,s,2o,2s.27 have used receiver operator characteristic (ROC) analysis to determine the optimum PSV ratio. Ranke et al, 20 Legemate et al" and Leng et aF8 have all shown a good correlation between PSV ratio and arteriographic diameter reduction up to 75% reduction and concluded by ROC analysis that the optimum PSV ratio cut-off for the prediction of a >50% diameter stenosis was 2.4, 2.5 and 3.0 respectively.…”