Screening for aortoiliac lesions by visual interpretation of the common femoral Doppler waveform

Objective: to study the accuracy of simple visual interpretation of the common femoral artery Doppler waveform for screening the aorto-iliac segment for significant occlusive disease. Design: prospective and semi-blinded study. Material: ninety-four consecutive and elective patients having arteriography duc to chronic lower limb ischaemia, presenting symptoms of severe claudication (23%), ischaemic rest pain (34%) or ischaemic skin lesions (43%). Methods: one day prior to conventional arteriography a Doppler waveform was obtained in the common femoral artery. Based on visual interpretation, the waveforms were immediately categorised as normal or abnormal. Comparison with single plane arteriography with respect to significant aorto-iliac occlusive disease was undertaken, Results: visual Doppler waveform interpretation had a sensitivity of 98% (95% CI: 90-100%), a specificity of 81% (CI: 67-90%.), a positive predictive value of 86% (CI: 75-93%) and a negative predictive value of 97% (CP 86-100%) for prediction significant aorto-iliac occlusive disease using conventional arteriography as the gold standard. The kappa value for the agreement between Doppler waveform interpretation and arteriography was 0.81 (0.68-0.93), representing very good agreement. Conclusion: a normal common femoral Doppler waveform can safely exclude significant upstream norto-iliac lesions and is a useful timesaving screening tool in the busy vascular laboratory. The method is well tolerated, easy to perform and requires no additional equipment.