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Screening patients with claudication from femoropopliteal disease before angioplasty using Doppler colour flow
M R Whyman1, I Gillespie, C V Ruckley
1Wolfson Unit for Prevention of Peripheral Vascular Diseases, Medical School, Edinburgh, UK.
Insights
Doppler colour flow imaging (DCFI) effectively screens patients with intermittent claudication for percutaneous transluminal angioplasty (PTA). This method reduces unnecessary arteriography, saving time, expense, and patient discomfort.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
Background:
- Arteriography for intermittent claudication is invasive, costly, and time-consuming.
- A non-invasive screening tool could optimize patient selection for percutaneous transluminal angioplasty (PTA).
Purpose of the Study:
- To evaluate Doppler colour flow imaging (DCFI) as a screening tool for hemodynamically significant lesions in intermittent claudication patients.
- To assess DCFI's accuracy in identifying lesions suitable for PTA compared to angiography.
Main Methods:
- 36 limbs in 30 patients with intermittent claudication underwent DCFI prior to angiography.
- Agreement and predictive accuracy between DCFI and angiography were calculated using kappa statistics, sensitivity, specificity, and predictive values.
Main Results:
- Excellent agreement (kappa = 0.91) was observed between DCFI and angiography for detecting significant lesions.
- DCFI demonstrated good predictive accuracy (kappa = 0.78) for identifying lesions amenable to PTA, with high sensitivity (94%) and specificity (85%).
Conclusions:
- DCFI is a valuable, non-invasive screening tool for intermittent claudication.
- Implementing DCFI can prevent unnecessary arteriography, leading to significant financial savings and improved clinical outcomes.
Abstract:
Time, expense, risk and discomfort are incurred by arteriography in patients with intermittent claudication who might be candidates for percutaneous transluminal angioplasty (PTA). A valid screening technique could reduce the need for arteriography in patients found to have lesions not amenable to PTA. Agreement between Doppler colour flow imaging (DCFI) and angiography for detecting haemodynamically significant lesions is high, but DCFI may not identify lesions suitable for angioplasty. A total of 36 limbs in 30 patients were studied using DCFI before angiography. Agreement between the two methods was excellent (kappa = 0.91), and the predictive accuracy of DCFI for lesions amenable to PTA was good (kappa = 0.78, sensitivity 94 per cent, specificity 85 per cent, positive predictive value 83 per cent, negative predictive value 94 per cent, overall accuracy 89 per cent). DCFI is a useful screening process that may prevent unnecessary angiography, with consequent financial savings and clinical benefit.