Ligush J Jr, Reavis SW, Preisser JS, Hansen KJ, et al.
Journal of vascular surgery. Date of publication 1998 Sep 1;volume 28(3):482-90; discussion 490-1.
1. J Vasc Surg. 1998 Sep;28(3):482-90; discussion 490-1.
Duplex ultrasound scanning defines operative strategies for patients with
limb-threatening ischemia.
Ligush J Jr(1), Reavis SW, Preisser JS, Hansen KJ.
Author information:
(1)Division of Surgical Sciences, Wake Forest University School of Medicine,
Winston-Salem, NC 27157, USA.
PURPOSE: To characterize the accuracy of color-flow duplex ultrasound (DUS) in
planning lower extremity revascularization procedures, we prospectively compared
operations predicted by means of DUS arterial scanning (DUSAS) and operations
predicted by means of conventional angiography (CA) with actual operations
performed in 36 patients undergoing 40 vascular reconstructions for critical
(grade II/III) lower extremity ischemia.
METHODS: All patients were examined with lower extremity DUSAS followed by CA.
DUSAS was performed from the aorta to the pedal vessels of the affected
extremity. Adequacy of inflow was assessed, and the best distal target vessel
with continuous, unobstructed flow was defined. An operative prediction was made
and recorded based upon the DUSAS findings, and in a blinded fashion, based upon
subsequent CA. The McNemar test for comparing correlated proportions was applied
to test for the statistical significance of the difference (P < .05) between
correct operations predicted by DUSAS and CA.
RESULTS: Of the actual operations performed, 83% were correctly predicted by
means of DUSAS (95% CI; range, 77% to 89%). Seven operations were incorrectly
predicted with DUSAS. Of the actual operations performed, 90% were correctly
predicted by means of CA (95% CI; range, 81% to 99%). Four operations were
incorrectly predicted with CA. The McNemar test determined that the difference
between correct operations predicted by means of DUSAS and correct operations
predicted by means of CA was not statistically significant (P = .50).
CONCLUSIONS: With few exceptions, DUSAS can be used to reliably predict
infrainguinal reconstruction strategies. Vessels defined as adequate with DUSAS
are rarely unfit for bypass. Prospective investigation of lower extremity
revascularization based solely upon DUSAS is warranted.
DOI: 10.1016/s0741-5214(98)70134-x
PMID: 9737458 [Indexed for MEDLINE]
