Comparison of contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities

Color flow duplex scanning was used to "map" the iliofemoral and femoral popliteal segments in 61 patients (84 extremities) undergoing evaluation for excimer laser angioplasty. Eight locations, iliac, common femoral, profunda femoris, proximal and distal superficial femoral artery, proximal and distal popliteal, and tibioperoneal trunk were scored as normal versus abnormal, greater than 50% stenosis, or occluded, and occlusions were measured in centimeters. Specificity, sensitivity, and accuracy were calculated with the arteriogram as the gold standard (83% and 96%, respectively, for normal vs abnormal, 87% and 99% for 50% stenosis, and 81% and 99% for occlusions). Color flow accurately identified the presence and extent of occlusions in 48 of 51 extremities (94%) when compared to arteriography plus operative findings, since arteriography alone tended to overestimate occlusion length. It is concluded that color flow Doppler alone may be used to screen patients with peripheral vascular disease to assess candidacy for endovascular procedures without antecedent arteriography, and that arteriography alone would exclude some patients from consideration by falsely overestimating occlusion lengths.