Duplex scanning as the sole preoperative imaging method for infrainguinal arterial surgery

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Medical Technology

Background:

• Infrainguinal arterial and aneurysmal disease often requires surgical reconstruction.
• Preoperative angiography has been the standard for evaluating disease extent and planning interventions.
• Minimally invasive diagnostic tools are sought to streamline surgical preparation.

Purpose of the Study:

• To assess the efficacy of preoperative duplex ultrasound as the sole diagnostic investigation before lower limb reconstruction.
• To compare the diagnostic accuracy and clinical outcomes of duplex ultrasound versus angiography.

Main Methods:

• Retrospective analysis of 329 surgical interventions for chronic infrainguinal arterial or aneurysmal disease.
• 157 interventions were performed without preoperative angiography, relying solely on duplex ultrasound findings.
• Comparison of duplex findings with on-table angiography and assessment of 30-day occlusion and 12-month patency rates.

Main Results:

• Duplex scanning correctly diagnosed stenosis and distal deep femoral artery status in femoral artery endarterectomy patients (except one).
• Duplex findings agreed with angiography for optimal outflow anastomotic site selection in 98% of bypass procedures.
• Duplex ultrasound accurately evaluated runoff status in 90% of cases, with no significant difference in occlusion or patency rates compared to angiography-guided reconstructions.

Conclusions:

• Conclusive preoperative duplex ultrasound findings negate the necessity for angiography prior to lower limb reconstruction.
• Duplex ultrasound is a reliable and effective tool for preoperative assessment in infrainguinal arterial disease.
• This approach can potentially reduce costs and patient inconvenience associated with angiography.