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International Angiology 2021 Apr 09

DOI: 10.23736/S0392-9590.21.04524-7


language: English

Duplex Ultrasound as a reliable alternative to CT angiography for treatment planning of Peripheral Artery Disease

Ombretta MARTINELLI, Alessia ALUNNO , Jihad JABBOUR, Simone CUOZZO, Roberto GATTUSO

Vascular Surgery Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy


BACKGROUND: The aim of this work is to compare the diagnostic accuracy of Duplex ultrasound (DUS) and CT angiography (CTA) in the study of arterial vessels, in patients with chronic peripheral arterial disease (PAD) of the lower limbs to undergo endovascular revascularization with the use of intraprocedural digital angiography (DSA).
METHODS: 94 patients with obstructive pathology of the arterial axes of the lower limbs were enrolled in the study. In all patients, endovascular revascularization treatment was considered the most suitable therapeutic choice. For this reason, ultrasound and CTA was performed preoperatively in all and based on the data obtained it was decided to classify the arterial tree into five segments: iliac, common femoral, superficial femoral, popliteal and infra-geniculate. According to the degree of stenosis or occlusion, the arteries were scored in no stenotic, stenotic and occluded. The comparison of the data provided by the DUS and the CTA was carried out with reference to the parameters obtained by the DSA.
RESULTS: The results of our experience have shown that in the iliac arterial district DUS proved to be less accurate than CT angiography when compared to DSA (Cohen's Kappa agreement of 0.91 and 1.0, respectively). Good diagnostic concordance were found in the femoro-popliteal district (Cohen's Kappa agreement 33 between 0.96 and 0.93). On the contrary, when the data of the infra-geniculate area were compared, CT angiography showed a net deficiency compared to DSA and DUS (Cohen's k: 0.75).
CONCLUSIONS: Due to its accuracy, high-quality DUS performed by well-trained operators may therefore represent a good alternative to CTA in patients undergoing endovascular revascularization, in order to reduce the use of contrast-enhanced radiological imaging especially when a condition of intolerance to the contrast medium and/or renal insufficiency coexists.

KEY WORDS: Peripheral arterial disease (PAD); Duplex ultrasound (DUS); Computed tomography angiography (CTA); Endovascular revascularization; Digital subtraction angiography (DSA)

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