Duplex ultrasonography rarely changes management decisions in chronic lower extremity ischemia

The purpose of this study was to determine the proportion of patients presenting with lower extremity pain whose treatment plan was altered by duplex ultrasonography. This prospective study evaluated all patients referred for lower extremity pain who had undergone a lower extremity arterial duplex scan. All patients underwent a history and physical examination by the same vascular surgeon. After the completion of the history and physical examination, the surgeon established a preliminary treatment plan. Subsequently, he reviewed the lower extremity duplex results and established a final treatment plan based on the history, physical examination, and duplex results. Treatment was labeled as either (1) conservative, (2) aggressive, or (3) the patient was considered to have no peripheral vascular disease. The proportion of patients whose primary treatment plan was altered by the addition of duplex ultrasonography was determined. Of 103 patients who entered the study, 7% had no peripheral vascular disease based on the history, physical examination, and duplex scan. Based on the history and physical examination alone, 48.5% were to be treated conservatively and 44.7% aggressively. After reviewing duplex results, the treatment plan was changed in only 5.9% of patients. There was no difference in treatment plan after the addition of the duplex results (p = 0.1025). Duplex ultrasonography remains a valuable tool in the evaluation of patients with lower extremity peripheral vascular disease; however, in most patients, the decision to treat conservatively or aggressively can be made without duplex scanning. All patients referred to the vascular clinic for lower extremity evaluation do not require a duplex scan.