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[Can ultrasonography replace arteriography in arteriosclerosis of the lower limb?]
1H:S Rigshospitalet, karkirurgisk afdeling. jonas.eiberg@dadlnet.dk
Insights
Arteriography is the standard for lower limb revascularization planning, but risks and limitations exist. Duplex arterial mapping offers a promising non-invasive alternative for predicting revascularization strategies and surgical locations.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
Background:
- Arteriography is the preferred imaging method for planning lower limb revascularization procedures like percutaneous transluminal angioplasty (PTA) or bypass grafting.
- However, arteriography carries a 2-3% complication risk and can face challenges with contrast filling in distal infrapopliteal arteries, questioning its gold standard status.
- The need for reliable non-invasive alternatives is therefore critical for patient safety and effective treatment planning.
Purpose of the Study:
- To evaluate duplex arterial mapping as a non-invasive alternative to arteriography for lower limb revascularization planning.
- To assess the reliability of duplex arterial mapping in predicting the type of revascularization procedure (bypass graft vs. endovascular).
- To determine the accuracy of duplex arterial mapping in identifying the precise locations for surgical anastomoses.
Main Methods:
- Review of existing literature and comparative analysis of arteriography and duplex arterial mapping techniques.
- Assessment of agreement rates for duplex arterial mapping in different arterial segments (femoral vs. infra-popliteal).
- Evaluation of duplex arterial mapping's predictive accuracy for procedural choice and surgical planning.
Main Results:
- Duplex arterial mapping demonstrates high agreement in the femoral segment but lower agreement in the infra-popliteal segment.
- The technique reliably predicts whether patients will require bypass grafting or an endovascular procedure.
- It also accurately predicts the locations for both proximal and distal anastomoses in cases requiring bypass surgery.
Conclusions:
- Duplex arterial mapping is a valuable and reliable non-invasive tool for planning lower limb revascularization.
- It can effectively guide treatment strategies, potentially reducing the need for invasive arteriography and its associated risks.
- Further research may focus on improving its accuracy in the infra-popliteal segment.
Abstract:
Arteriography is the imaging modality of choice before lower limb revascularization, because it allows pinpointing of the diseased arteries and planning of the treatment strategy, be it PTA or bypass grafting. However, a 2-3% risk of complications, makes assessment of non-invasive alternatives mandatory. Insufficient contrast filling of infrapopliteal arteries distal to severe lesions have also challenged the status of arteriography as the gold standard before revascularisation. The use of duplex arterial mapping is a promising alternative, as it has the highest agreement in the femoral segment and the lowest in the infra-popliteal segment. Duplex arterial mapping is a reliable means of predicting whether patients will require a bypass graft or an endovascular procedure, and, if surgery is required, in predicting the actual location of both anastomoses.