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Can preoperative duplex marking of the saphenopopliteal junction be avoided?
A A Kambal1, M Najem, D Jacobs
1Northwick Park Hospital, Harrow, UK. aakambal@hotmail.com
Insights
Hand-held Doppler (HHD) accurately marks saphenopopliteal junction (SPJ) reflux, potentially replacing a second duplex scan. This streamlines preoperative marking for SPJ surgery and reduces vascular lab workload.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Diagnostic Techniques
Background:
- Saphenopopliteal junction (SPJ) surgery often requires two duplex scans.
- A second preoperative duplex scan is used to accurately mark the SPJ.
Purpose of the Study:
- To evaluate if hand-held Doppler (HHD) can replace the second duplex scan for SPJ marking.
- To assess the accuracy of HHD in localizing the SPJ for surgery.
Main Methods:
- Sixty limbs with suspected SPJ reflux were studied.
- An initial duplex scan identified SPJ position relative to the popliteal crease.
- Hand-held Doppler (HHD) was used to mark the SPJ, with < or =10 mm deviation from the duplex scan considered acceptable.
Main Results:
- HHD achieved 100% accuracy in localizing 27 patients with SPJ reflux (0-5 mm deviation).
- For SPJ without reflux (25 patients), HHD accurately localized 22 (88%) with 0-16 mm deviation.
Conclusions:
- Hand-held Doppler (HHD), guided by initial duplex scans, accurately marks SPJ with reflux.
- A second duplex scan is unnecessary for preoperative SPJ marking.
- Implementing HHD can decrease the workload in vascular laboratories.
Objectives:
Patients undergoing saphenopopliteal junction (SPJ) surgery are currently subjected to two duplex scans. The first is to confirm the reflux, and the second is done preoperatively to accurately mark the SPJ for surgery. The aim of this study was to assess whether the use of hand-held Doppler (HHD) can substitute the second duplex scan.
Methods:
Sixty limbs with suspected SPJ reflux were studied. Patients underwent an initial duplex scan. The report detailed the position of SPJ in relation to popliteal crease. Guided by this, a HHD was then used to mark the SPJ. Deviation of the HHD mark from the duplex one of < or =10 mm was considered acceptable for surgical accuracy.
Results:
HHD accurately localized all 27 patients with SPJ reflux (100% accuracy). The distances between the HHD and duplex points in this group ranged between 0 and 5 mm (median=0). Twenty-five patients had SPJ with no reflux, and 22 of them were accurately localized (88%). The distances between the two points in the latter group ranged between 0 and 16 mm (median=3).
Conclusion:
HHD, guided by the routine duplex scan, can accurately mark SPJ with reflux. A second duplex is not required for marking prior to surgery. This will reduce the workload of the vascular laboratory.
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