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Noninvasive localization of arterial occlusive disease: a comparison of segmental Doppler pressures and arterial
G L Moneta1, R A Yeager, R W Lee
1Department of Surgery, Oregon Health Sciences University, Portland 97201.
Insights
Arterial duplex mapping significantly outperforms segmental Doppler pressures in locating significant arterial blockages in the legs. This noninvasive technique offers superior accuracy for diagnosing lower extremity arterial occlusive disease.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Noninvasive Vascular Testing
Background:
- Lower extremity arterial occlusive disease is a significant cause of morbidity.
- Accurate localization of arterial lesions is crucial for effective treatment planning.
- Noninvasive diagnostic methods are preferred when feasible.
Purpose of the Study:
- To compare the diagnostic accuracy of arterial duplex mapping versus segmental Doppler pressures.
- To determine the effectiveness of these methods in localizing hemodynamically significant arterial stenosis.
- To evaluate their utility in the iliac, superficial femoral, and popliteal arteries.
Main Methods:
- A blinded comparison of arterial duplex mapping and segmental Doppler pressures against angiographic controls.
- Evaluation of 151 lower extremities from 79 patients with suspected arterial occlusive disease.
- Assessment of localization accuracy for high-grade stenoses (50%-100%).
Main Results:
- Arterial duplex mapping demonstrated higher sensitivity and specificity rates across all evaluated arterial segments compared to segmental Doppler pressures.
- Complete agreement with angiography was achieved in 82% of cases with arterial duplex mapping versus 34% with segmental Doppler pressures (p < 0.0001).
- Factors like diabetes, kidney failure, or prior surgery did not impact the accuracy of either test.
Conclusions:
- Arterial duplex mapping is a superior noninvasive method for localizing high-grade arterial lesions in the lower extremities.
- Segmental Doppler pressures are less accurate for precise localization of arterial stenosis.
- Arterial duplex mapping should be considered the preferred modality for evaluating hemodynamically significant lower extremity arterial occlusive disease.
Purpose:
The purpose of this study was to compare the abilities of arterial duplex mapping and segmental Doppler pressures to noninvasively localize hemodynamically significant lower extremity arterial occlusive disease.
Methods:
After angiographic controls were instituted, arterial duplex mapping and segmental Doppler pressures were blindly compared for their ability to localize a high-grade (50% to 100%) stenosis to the iliac or common femoral arteries, the superficial femoral artery, or the popliteal artery in 151 lower extremities from 79 patients.
Results:
Rates of sensitivity and specificity of arterial duplex mapping for identifying a high-grade stenosis at the three arterial levels were 88% and 97%, 95% and 100%, and 78% and 99%, respectively. Those for segmental Doppler pressures were 59% and 86%, 73% and 80%, and 48% and 53%, respectively. There was complete agreement between arterial duplex mapping and angiography in 82% of the limbs studied and between segmental pressures and angiography in 34% of the limbs (p < 0.0001). The presence of diabetes, kidney failure, or previous vascular surgery in the limb studied did not affect the accuracy of either test.
Conclusion:
Arterial duplex mapping is far superior to segmental Doppler pressures for localization of high-grade angiographic lesions from the iliac to the popliteal arteries.