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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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ORIGINAL ARTICLE  DIAGNOSTICS AND TREATMENT MODALITIES FOR OBSTRUCTIVE AND ANEURYSMATIC ILIAC ARTERY DISEASE


The Journal of Cardiovascular Surgery 2018 February;59(1):37-44

DOI: 10.23736/S0021-9509.17.10186-2

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Hemodynamic significance assessment of equivocal iliac artery stenoses by comparing duplex ultrasonography with intra-arterial pressure measurements

Stefan G. HEINEN 1, 2 , Sanne W. de BOER 3, Daniel A. van den HEUVEL 3 , Wouter HUBERTS 2, Patricia DEKKER 4, Frans N. van de VOSSE 5, Tammo DELHAAS 2, Jean-Paul de VRIES 1

1 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; 2 Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; 3 Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands; 4 Department of Clinical Neurophysiology, St. Antonius Hospital, Nieuwegein, The Netherlands; 5 Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands


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BACKGROUND: This study evaluated the accuracy of duplex ultrasonography (DUS)-based peak systolic velocity ratio (PSVR) and ipsilateral common femoral artery (CFA) velocity waveform analysis to identify a hemodynamically significant equivocal iliac artery stenosis (30-75% lumen diameter reduction). Intra-arterial pressure measurements were used as a reference.
METHODS: In a previously performed prospective study (NTR5085), 30 patients with 35 iliac artery stenoses underwent intra-arterial angiography. To determine the hemodynamic significance of the iliac artery stenoses, intra-arterial translesional pressure measurements were performed under hyperemic conditions. Preprocedural DUS was obtained of the iliac and femoral arteries. PSVR over the iliac lesions was determined, and ipsilateral CFA velocity waveforms were retrospectively classified. The intraobserver and interobserver agreement for CFA velocity waveform classification were evaluated. Sensitivity, specificity, and overall accuracy were calculated by comparing PSVR, velocity waveform analysis, and a combination of these parameters to the intra-arterial translesional pressure gradient. A translesional pressure gradient ≥10 mmHg, PSVR ≥2.5, and a monophasic or biphasic CFA velocity waveform were considered to be indicative for a hemodynamically significant iliac artery stenosis.
RESULTS: For classification of ipsilateral CFA velocity waveforms, intraobserver and interobserver agreement were 0.94 and 0.82, respectively. A PSVR ≥2.5 could identify a hemodynamically significant stenosis with 83% sensitivity, 67% specificity, and an overall accuracy of 77%. When both a monophasic and a biphasic velocity waveform were considered to indicate a hemodynamically significant iliac artery stenosis, sensitivity was 78%, specificity was 50%, and the overall accuracy was 69%. The combination of a PSVR ≥2.5 with either a monophasic or a biphasic CFA velocity waveform was found in 20 stenoses and resulted in 94% sensitivity, 75% specificity, and 90% accuracy. When the remainder of the stenoses (N.=15) was classified by means of the PSVR, the overall accuracy remained 77%.
CONCLUSIONS: DUS is a very useful noninvasive imaging modality to determine the significance of an iliac artery stenosis. A combination of translesional PSVR ≥2.5 with either a monophasic or a biphasic ipsilateral CFA ultrasound waveforms has a good accuracy and helps to select patients that benefit most from follow-up examination by computed tomography angiography or magnetic resonance angiography.


KEY WORDS: Peripheral arterial disease - Ultrasonography, Doppler, Duplex - Blood pressure determination

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Publication History

Issue published online: November 28, 2017
Article first published online: August 29, 2017
Manuscript accepted: August 28, 2017
Manuscript received: August 25, 2017

Per citare questo articolo

Heinen SG, de Boer SW, van den Heuvel DA , Huberts W, Dekker P, van de Vosse FN, et al. Hemodynamic significance assessment of equivocal iliac artery stenoses by comparing duplex ultrasonography with intra-arterial pressure measurements. J Cardiovasc Surg 2018;59:37-44. DOI: 10.23736/S0021-9509.17.10186-2

Corresponding author e-mail

s.heinen@antoniusziekenhuis.nl