Can ultrasound replace arteriography in the management of chronic arterial occlusive disease of the lower limb?

Objectives: to investigate whether colour duplex scanning can be used as the sole diagnostic investigation prior to lower limb revascularisation. Patients and Methods: the results of angiography and duplex were compared in 80 limbs (69 claudication, 11 critical limb ischaemia [CLI]) from tig patients. Results: excellent diagnostic agreement (kappa value 0.89, 95% CI 0.85-0.93) was achieved at the femeropopliteal segment. Agreement was good for the aorto-iliac segment (kappa value 0.69, 95% CI 0.61-0.77) and moderate for the infrapopliteal segment (kappa value 0.59, 95% CI 0.55-0.63). Similarly, in the decision-making process excellent agreement was achieved for the femoropopliteal segment (kappa value 0.91, 95% CI 0.88-0.94), good for the aortoiliac segment (kappa value 0.62, 95% CI 0.56-0.68), and moderate for the infrapopliteal segment (kappa value 0.46, 95% CI 0.42-0.50). Duplex detected patent 12 tibial arteries in 10 limbs that were not opacified on arteriography. In four limbs duplex revealed significant disease in the above knee popliteal artery that was missed on arteriography. Conclusions: treatment of femoropopliteal disease carl be based upon duplex alone in the great majority of cases. However, where there is disease in the aortoiliac segment, or where infrapopliteal revascularisation is long considered both duplex and angiography should be performed to maximise pre-operative information.