Can duplex scan arterial mapping replace contrast arteriography as the test of choice before infrainguinal revascularization?

Purpose: Arteriography is the diagnostic test of choice before lower extrem ity revascularization, because it is a means of pinpointing stenotic or occ luded arteries and defining optimal sites for the origin and termination of bypass grafts. We evaluated whether a duplex ultrasound scan, used as an a lternative to arteriography could be used as a means of accurately predicti ng the proximal and distal anastomotic sites in patients requiring peripher al bypass grafts and, therefore, replace standard preoperative arteriograph y. Methods: Forty-one patients who required infrainguinal bypass grafts underw ent preoperative duplex arterial mapping (DAM). Based on these studies, an observer blinded to the operation performed predicted what operation the pa tient required and the best site for the proximal and distal anastomoses. T hese predictions were compared with the actual anastomotic sites chosen by the surgeon. Results: Whether a femoropopliteal or an infrapopliteal bypass graft was re quired was predicted correctly by means of DAM in 37 patients (90%). In add ition, both anastomotic sites in 18 of 20 patients (90%) who had femoropopl iteal bypass grafts and 5 of 21 patients (24%) who had infrapopliteal proce dures were correctly predicted by means of DAM. Conclusion: DAM is a reliable means of predicting whether patients will req uire femoropopliteal or infrapopliteal bypass grafts, and, when a patient r equires a femoropopliteal bypass graft, the actual location of both anastom oses can also be accurately predicted. Therefore, DAN appears able to repla ce conventional preoperative angiography in most patients found to require femoropopliteal reconstruction. Patients who are predicted by means of DAM to require crural or pedal bypass grafts should still undergo preoperative contrast studies to confirm these results and to more precisely locate the anastomotic sites.