Peripheral arterial disease: assessment by arteriography and alternative noninvasive measurements

In most centers arteriography is the sole method used to investigate peripheral arterial disease. In view of the availability of other noninvasive techniques, this practice must be reappraised. Among 3,000 patients with peripheral arterial disease, 40% of those undergoing arteriography were found unsuitable for reconstructive arterial surgery primarily because of poor arterial runoff. Noninvasive assessment techniques are discussed, including sequential arterial scanning with Doppler ultrasound. In a single-blind comparison of Doppler ultrasound scanning and arteriography, findings by ultrasound were confirmed by arteriography in 265 of 267 examinations. Blood pressure measurements in the limbs as well as fluorescence and radioisotope clearance studies also provide valuable information. It is recommended that a more rational approach to the assessment of peripheral arterial disease be considered, particularly in elderly patients, to safeguard against undue discomfort and risk. Arteriography should be reserved for patients undergoing reconstructive surgical procedures.