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Published on: September 22, 2020
Analysis of Doppler ultrasonography and computer tomography angiography for predicting amputation level and
Levent Adiyeke1, Bekir Karagoz2
1Department of Orthopedics and Traumatology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkiye.
Insights
Doppler ultrasound and CT angiography effectively predict lower extremity amputation levels. Accurate blood flow assessment in the primary surgical phase is crucial for reducing reamputation rates in peripheral arterial disease patients.
Area of Science:
- Vascular Surgery
- Radiology
- Medical Imaging
Background:
- Peripheral arterial disease is a leading cause of non-traumatic lower extremity amputations.
- Accurate assessment of distal vascular structures is vital for surgical planning.
Purpose of the Study:
- To evaluate the predictive efficacy of Doppler ultrasound and CT angiography in determining amputation levels.
- To assess the relationship between imaging findings and reamputation rates.
Main Methods:
- Retrospective analysis of 166 patients undergoing lower extremity amputation.
- Review of demographic data, comorbidities, reamputation data, and radiological reports (Doppler ultrasound, CT angiography).
Main Results:
- Amputation levels varied: above knee (36.7%), below knee (38.6%), and foot/finger (24.7%).
- Occlusion patterns correlated with amputation level (e.g., iliac artery occlusion in above-knee amputations).
- Reamputation rates were highest with popliteal artery occlusions.
Conclusions:
- Radiological data (Doppler ultrasound, CT angiography) are effective in planning amputation levels based on blood flow.
- Determining the precise level of blood flow during the initial surgical phase is directly linked to reamputation rates.
Objective:
Peripheral arterial disease of the lower extremities is one of the most common causes of non-traumatic lower extremity amputation. Computed tomography (CT) angiography and Doppler ultrasonography are mainly used to evaluate distal vascular structures. Our objective was to evaluate the predictive efficacy of Doppler ultrasound and CT angiographic radiographic examinations in determining amputation levels and reamputation rates in patients undergoing lower extremity amputation.
Methods:
Patients with major or minor amputation at various levels due to lower extremity lesions were included in the study. Standard demographic information, clinical accompanying diseases, reamputation datas, Doppler ultrasound, and CT angiography radiological evaluation reports were obtained retrospectively from the hospital system records of the patients.
Results:
A total of 166 cases including 119 (71.7%) males and 47 (28.3%) females were included in the study. About 36.7% (n=61) cases had amputation at the level of surgery above the knee, 38.6% (n=64) below the knee and 24.7% (n=41) at the level of foot/finger. In patients who underwent amputation above the knee, occlusion was seen at the level of the iliac artery (88.9%), femoral artery (47.8%), and popliteal artery (37%). The rate of occlusion at the level of the popliteral artery in patients with below-knee amputation (59.3%) was found in patients with foot/finger amputation (51.5%) at the levels arteria dorsalis pedis and posterior tibial artery. According to the level of occlusion at all blood flow levels, it was observed that the rate of reamputation was most common in occlusions at the level of popliteal artery.
Conclusion:
It was found that radiological data are effective in planning amputation according to blood flow level and does not make any difference per se. It was found that the reamputation rates were related to the determination of the level of blood flow in the primary surgical phase.
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