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[Duplex sonography and ankle-brachial index in lower limb arterial disease: practical approach]
1Service de Radiologie Cardio-Vasculaire, Hôpital Européen Georges Pompidou, 20-40, rue Leblanc, 75908 Paris Cedex 15.
Insights
This report harmonizes clinical practices for lower limb arterial Duplex Sonography. It provides a consensual guide for equipment, examination, and application in various arterial disease scenarios.
Area of Science:
- Vascular Medicine
- Cardiovascular Imaging
- Health Technology Assessment
Background:
- Practices and diagnostic criteria for lower limb arterial Duplex Sonography show significant variability.
- Societies in Vascular Medicine and Cardio-Vascular Imaging initiated a Health Technology Assessment (HTA) report.
- The HTA Working Group aimed to foster harmonization in clinical practices.
Purpose of the Study:
- To establish a consensual approach for Duplex Sonography in lower limb arterial disease.
- To address the variability in diagnostic criteria and clinical practice.
- To promote standardization in the field.
Main Methods:
- A working document was developed and circulated among an HTA Working Group and a Reading Group.
- The document underwent review and recommendations from both groups.
- A final version was compiled incorporating feedback.
Main Results:
- A consensual practical approach was defined for lower limb arterial Duplex Sonography.
- Key areas covered include minimal equipment, examination procedures, and appropriate clinical indications.
- Guidance is provided for asymptomatic patients, claudication, critical ischemia, therapeutic support, and non-indicated situations.
Conclusions:
- This document represents a unique initiative for a consensual guide in France on this topic.
- It is intended as a practical guide for professionals, not formal ANAES guidelines.
- It serves as a foundation for future development of official recommendations.
Objective:
The Société Française de Médecine Vasculaire and Société Française d'Imagerie Cardio-Vasculaire requested that ANAES perform an Health Technology Assessment (HTA) report entitled "Duplex Sonography in Lower Limb Arterial Disease". This report showed a wide variability of practices as well as for diagnostic criteria. The HTA Working Group wished to express that there was a consensual opinion to promote clinical practice harmonization.
Method:
A working document was sent to the HTA Working Group and to a specifically selected Reading Group. A direct draft report was transcribed during the last Working Group meeting. This document was then sent to both Working Group and Reading Group for review and recommendations. The final version takes into account these comments.
Results:
The consensual practical approach concerns the minimal equipment required to carry out a lower limb arterial Duplex Sonography, examination proceeding and its place according to the clinical situations (asymptomatic patient, claudication, critical ischemia, therapeutic situations support, clinical situations where Duplex Sonography is not justified).
Conclusion:
The document represents a special initiative of the Working Group implemented in the context of an ANAES HTA report. This document should not be considered as ANAES professional guidelines since its working method was not compliant with the ANAES method used to elaborate guidelines. Importantly, it represents the first consensual finalised document regarding this topic in France. It should be considered as a practical guide for professional use, and serve as a basis for the development of recommendations.