The additional value of angiography after colour-coded duplex on decision making in patients with critical limb ischaemia : A prospective study

Objective; to investigate prospectively the additional value of intra arterial digital subtraction arteriography (IADSA) for decision making in patients with critical limb ischemia (CLI). Treatment plaits based oil colour-duplex imaging (CDI) were compared with treatment plaits based on IADSA. Methods: ninety-eight consecutive patients with 112 legs with CLI were investigated by CDI and IADSA. Treatment plaits based on CDI and IADSA were made separately during a multidisciplinary meeting. Both plans were retrospectively analysed with the outcome of the operation or the endovascular procedure as a reference. Results: eighty-eight patients with 101 legs could be analysed. lit 91 out of the 101 legs (90%) CDI offered the same strategy as the IADSA. In 10 legs IADSA provided additional information. Most of the additional information Concerned the crural vessels. Conclusion: the preoperative planning of treatment in patients with chronic critical ischaemia of the lower limbs call be based on CDI alone in most patients. For planning crural revascularisation additional information may be needed. If severe calcification prevents adequate visualisation of the crural vessels or no patent anterior or posterior tibial artery with outflow across the ankle is present, IADSA should be performed.