Vascular surgery without arteriography: use of duplex ultrasound

Although contrast arteriography has served as the historical 'gold standard ' for diagnosis of arterial disease, recent improvements in noninvasive dia gnostic methods have made it possible to plan surgical treatment without su bjecting patients to this invasive procedure. This approach avoids both the risks and costs associated with arteriography, Duplex scanning has become the standard noninvasive test for extracranial carotid artery disease. and it can also be used to directly evaluate the lower extremity arteries. In a ddition to the standard duplex criteria for classification of carotid steno sis, new criteria are available that reflect the stenosis thresholds identi fied in randomized clinical trials. Clinical experience has clearly shown t hat carotid endarterectomy can be performed safely based on the duplex scan alone in the majority of patients; however, arteriography is still indicat ed in selected cases. The evaluation of lower extremity arterial disease re quires examination of multiple arterial segments, and most vascular surgeon s still rely on the anatomic detail provided by arteriography for preoperat ive planning. Still. it may be possible to avoid formal preoperative arteri ography in selected patients by using a combination of lower extremity dupl ex scanning and intraoperative arteriography. Further developments in nonin vasive testing will continue to reduce the need for diagnostic arteriograph y prior to direct arterial surgery. (C) 1998 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reser ved.