The role of duplex scanning in decision making for patients with claudication

The aim of this study was to compare the accuracy of clinical decisions made for patients presenting with claudication on the basis of the ankle/brachial index (ABI) (at rest and postexercise) and duplex scanning with that made on the basis of angiograms. Fifty-six patients presenting with a history suggestive of claudication had the ABI taken at rest. Seven patients could not be exercised but their resting ABI was <0.8. Additional exercise testing was done in 49 patients; two were then excluded as there was no fall in the ABI. Thus, 54 patients were entered into the study and underwent color-flow duplex scans and angiography. A clinical decision was reached independently on the basis of the results of ABI and duplex scans as to a) conservative treatment, b) angioplasty, and c) surgery. This was compared to the decision reached on the basis of angiograms. The results show that the combined use of ABI (as a screening test) and duplex scanning can replace angiography for clinical decision making in nearly 80% of claudicants. Angiography will only be needed when duplex scans are inconclusive.