Lower-extremity Revascularisation Without Preoperative Contrast Arteriography in 185 Cases: Lessons Learned with Duplex ultrasound Arterial Mapping

Abstract

contrary to general belief, these data show that high-quality arterial ultrasonography represents a safe alternative to preoperative CA, even for infrapopliteal bypasses. This non-invasive approach may be especially useful for patients with contrast allergy or impaired renal function.

Ultrasound Imaging in Vascular Diseases

“…However, in recent years, duplex ultrasonography (DA) has gained a major role in the pre-operative evaluation of patients undergoing lower extremity bypass (Ascher et al, 1999;Grassbaugh et al, 2003;Ligush et al, 1998;Pemberton et al, 1996;Proia et al, 2001). Mazzariol et al reported that the use of dupplex ultrasonography can provide enough information for surgery in more than 83% of patients with arterial stenosis and that an abnornal femoral artery waveform was 100% predictive for detecting stenosis greater than 80% (Mazzariol et al, 2000) Proia et al have also confirmed these results (Proia et al, 2001). In comparison with conventional angiography or MRA, DA has a lower sensitivity for detecting arterial disease of the lower extremity.…”

The Use of Duplex Ultrasound Arterial Mapping (DUAM) and Preoperative Diagnostics in Patients with Atherosclerotic Ischaemia of Lower Extremities

“…one of the main reasons for giving-up using DUAM for routine preoperative diagnostic is long duration of the assessment, estimated at 39-75 minutes (1,14,19). In our study, full mapping of arteries in both lower extremities lasted 16 -34 minutes (21.1 minutes on the average) Such significant differences may result from experience acquired by researchers in the course of duplex scans.…”

“…In contrast, Ascher found 100% consistency for planning of thromboectomy, embolectomy and by-passes of thrombosed aneurysms of popliteal arteries and just 94% consistency for qualifying for bypasses in the ilio-femoro-popliteal section (2,14). According to Mazzariol, the level of consistency between DUAM results and actual procedures depends on the scope of use of available measurement techniques (1). A direct assessment of the iliac arteries in the 2D mode and with a colour Doppler feature allowed correct diagnoses of 94% of haemodynamically significant lesions.…”

“…Since 1985 a growing body of evidence has been showing usefulness of duplex ultrasound arterial mapping (DUAM) as a single scan qualifying patients with peripheral artery occlusive disease (PAoD) for surgical treatment and as a method of imaging during intravascular surgeries (1)(2)(3)(4)(5)(6)(7)(8). Ascher limited the use of fluoroscopy during stenting of carotid arteries exclusively to the time of catheterisation of the common carotid arteries (9).…”

New simple image overlay system using a tablet PC for pinpoint identification of the appropriate site for anastomosis in peripheral arterial reconstruction

“…The incision site for distal anastomosis in crural or pedal bypass surgery is often established preoperatively using color-assisted duplex ultrasonography (US) with reference to the results of these imaging examinations [3][4][5][6][7][8][9][10][11]. However, precise identification of the arterial portion for distal anastomosis using US is sometimes difficult, because of severe arterial calcification or the depth of the target vessel [10], and its accuracy is dependent on the skills of the operator [6][7][8]12].…”