Selection of Patients with Lower Limb Arterial Occlusive Disease for Endovascular Treatment of the Iliac Arteries with Duplex Scanning

Abstract

The aim of this study was to evaluate the role of duplex scanning in selection of patients with lower limb arterial occlusive disease for endovascular treatment of the iliac arteries. From January 1995 through May 2000, 183 patients having chronic lower limb arterial insufficiency who underwent duplex scanning of the lower extremity arteries with available aortoiliac scans within 3 months before conventional aortoiliac diagnostic angiography and/or endovascular intervention of the iliac arteries were studied retrospectively. The findings obtained from duplex scanning and angiography were analyzed in a blinded manner by 2 investigators. Limbs having category 1, 2, and 3 lesions according to duplex scan findings were interpreted as being suitable for endovascular intervention. The comparison between duplex scan findings and angiography was analyzed by the third investigator. During 93 percutaneous transluminal angioplasty (PTA) procedures, 133 arterial segments, common or external iliac, were dilated with stent placement in 70. Bilateral interventions were performed in 25 cases, and of 68 unilateral interventions, 57 were at only 1 arterial segment. The accuracy, sensitivity, specificity, and negative and positive predictive values of duplex scanning to appropriately categorize the iliac artery lesions into suitable or unsuitable for endovascular intervention were 90%, 95%, 83%, 90%, and 92%, respectively when the inconclusive duplex scans were excluded (11%). In 6 patients with lesions suitable for PTA according to duplex scanning and angiography, PTA was not performed owing to clinical reasons. The accuracy of duplex scanning in predicting the performance of endovascular intervention was 88%. It is concluded that iliac artery endovascular procedures in limbs with chronic occlusive disease can be reliably planned according to duplex scan findings.

ESVM Guideline on peripheral arterial disease

“…This was demonstrated by a retrospective evaluation of intraoperative and/or peri-interventional digital subtraction angiography (DSA) images of 4,783 patients with infrainguinal Transatlantic Inter-Society Consensus (TASC) C and D lesions. With a sensitivity of 97 % and a specificity of 98 %, CCDS as sole diagnostic method was successfully used in treatment planning and decision-making for bypass surgery or endovascular treatment [81]. With CCDS, important differential diagnoses can be identified, including vasculitis, muscular compression syndrome, aneurysmal vascular occlusion, and rare cystic adventitial degeneration.…”

“…Duplex sonography is widely available, non-invasive, reproducible and biologically inert. Applied by experienced investigators, it shows high levels of sensitivity and specificity [82,83] and, based on reliable findings, facilitates the safe planning of necessary treatment steps (conservative treatment, catheter intervention, bypass surgery) [81]. It provides morphological imaging of vascular walls, perivascular tissue or details of early atherosclerotic change by capturing intima-media thickness (IMT), and thus delivers a valuable parameter for clinical studies [64,84].…”

Estudo comparativo de eco-Doppler com arteriografia na avaliação da doença oclusiva aorto-ilíaca

“…A outra é que a eco-Doppler permite selecionar os pacientes com lesões mais graves, mas bem localizadas, que são candidatos a terapia intervencionista por cateter [39][40][41][42][43][44][45][46][47][48][49][50][51][52] . Tradicionalmente, os candidatos a essa forma de terapia têm que ser submetidos a dois exames arteriográficos: um exame diagnóstico e um segundo exame, durante o qual é executada a intervenção.…”

“…Essa conclusão está de acordo com quase todos os trabalhos da literatura 8,[25][26][27][28][29][30][31][32][33][34][35][36][37][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] . A eco-Doppler pode ser usada na investigação primária da DOAI, evitando-se a angiografia pré-intervenção por qualquer método (arteriografia com cateter, tomografia computadorizada e ressonância magnética) na imensa maioria dos pacientes com suspeita de DOAI.…”

A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease

“…Patients with asymptomatic disease also have an increased risk of mortality. 4 It has been estimated that, of every 100 patients presenting to their GP with intermittent claudication, over the next 5 years symptoms will improve in 50, remain stable in 25 and deteriorate in 25. Of the 25 legs that worsen five will need intervention and two to five will need a major amputation.…”