DUPLEX SCANNING FOR GRADING AORTOILIAC OBSTRUCTIVE DISEASE AND GUIDING TREATMENT

Standard assessment of aortoiliac obstructive disease (AIOD) includes arteriography preferably supplemented with femoral artery pressure (FA P) measurements. This study investigated the value of Duplex scanning in classifying AIOD and compared the outcome of Duplex scanning with c linical decision making. One-hundred-and-fifty-three aortoiliac segmen ts of 87 patients were prospectively examined by Duplex scanning, arte riography, and FAP measurements to establish the presence or absence o f significant AIOD. The results of these tests were compared to each o ther and to the subsequent vascular interventions and their success ra tes. Excellent agreement (kappa 0.82) was found between Duplex scannin g and arteriography. The agreement between Duplex scanning and FAP mea surements was much lower (kappa 0.52). The correlation between the per formed treatment and the assessment of AIOD by Duplex scanning or arte riography was good, whereas the FAP results correlated only moderately with the performed treatment. Endovascular or operative treatment was actually performed in only 63% of the aortoiliac segments with an abn ormal FAP test (success rate 80%). Aortoiliac segments with significan t AIOD according to arteriography or Duplex scanning were treated inva sively in 86% (success rate 81%) and 82% (success rate 80%), respectiv ely. In conclusion, Duplex scanning can replace arteriography as a scr eening tool for the identification of treatable aortoiliac lesions whe reas the value of FAP measurements in the decision making process is l imited.