COLOR DOPPLER IMAGING IN ADJUNCT TO CONTRAST ARTERIOGRAPHY IN EVALUATION OF SEVERE PERIPHERAL VASCULAR-DISEASE

Of the 309 patients operated on for revascularization of lower extremi ties 29 (9.4%) had a conventional contrast arteriography that failed t o opacify at least one vessel that was found to be patent by color Dop pler imaging plus surgical exploration. The indication for vascular im aging was rest pain in 12 patients, claudication in 7, nonhealing ulce rs in 3, and gangrene in 3; 4 patients had more than one indication. I n 20 (69%) of 29 patients infrapopliteal runoff vessels were the cause for misdiagnosis. In all patients with failed arteriography a total o cclusion proximal to the misidentified vessel was present. As a common finding, peak systolic velocities were less than 0.5 m/second in misd iagnosed suprapopliteal arteries and less than 0.25 m/second in infrap opliteal arteries. At operation direct surgical exploration confirmed the diagnosis of color Doppler imaging in all 29 patients. The judgmen t that the operation was successful was based upon intraoperative arte riography, relief of symptoms, warmness of the feet, palpable pulses, and color Doppler imaging performed one month after the operation. Exc ellent short-term results were obtained in 27 patients; one early and three late graft occlusions were detected in a mean follow-up of twent y months. In conclusion, color Doppler imaging is an excellent and con venient technique for evaluation of patients with peripheral vascular disease. It demonstrates suitable blood vessels for revascularization that are not seen on contrast arteriography. In the authors' opinion, color Doppler imaging is a clinically useful adjunct to conventional c ontrast arteriography and should be performed in patients in whom arte riography has failed to show any suitable target vessel for revascular ization.