VALUE OF COLOR DUPLEX SONOGRAPHY FOR EVALUATION OF TIBIOPERONEAL ARTERIES IN PATIENTS WITH FEMOROPOPLITEAL OBSTRUCTION - A PROSPECTIVE COMPARISON WITH ANTEROGRADE INTRAARTERIAL DIGITAL SUBTRACTION ANGIOGRAPHY

Purpose: This study investigated the accuracy of color duplex sonograp hy (CDS) compared with anterograde intraarterial digital subtraction a ngiography in the evaluation of the tibioperoneal arteries in patients with peripheral arterial occlusive disease. Methods: Fifty consecutiv e patients with femoropopliteal obstruction were examined immediately before planned percutaneous transluminal angioplasty. All CDS examinat ions were performed by one observer; the angiograms were interpreted i ndependently by two readers (A1, A2). We compared agreement concerning judgement of the dominant crural artery (suitable for an eventual fem orocrural bypass operation) and judgement of the severity of arterial lesions. Results: Concerning judgement of the dominant artery, the int erobserver agreement between the two readers of the angiograms was bet ter (kappa value, 0.76) than the agreement between CDS versus A(1) (0. 61) and CDS versus A(2) (0.56). However, the differences were not stat istically significant. The results were independent (no significant di fferences in the kappa values) of the following criteria: presence of diabetes; clinical stage of peripheral arterial occlusive disease; kin d of femoropopliteal obstruction; and status of the popliteal artery. Concerning the evaluation of the severity of arterial lesions, the kap pa values were significantly higher (p < 0.05) for A(1) versus A(2) (p osterior tibial, 0.87; anterior tibial, 0.79; peroneal, 0.52) than for CDS versus A(1) (0.51; 0.46; 0.07) and CDS versus A(2) (0.35; 0.38; - 0.05). The sensitivity of CDS (vs A(1) as reference) for detecting a h emodynamically relevant arterial lesion (stenosis or occlusion) was 10 0% in the posterior tibial artery, 78% in the anterior tibial artery, and 92% in the peroneal artery. Conclusion: Compared with intraarteria l anterograde digital subtraction angiography, the value of CDS-with i ts currently used technology-for evaluation of the dominant lower leg artery suitable for an eventual femorocrural bypass operation in patie nt's who have femoropopliteal obstruction is limited. It cannot replac e an accurate preoperative angiogram for the routine clinical practice , and its use should be restricted to special cases (such as patients with a history of severe allergic reaction to contrast media or of sev erely impaired kidney function). CDS is also limited in the accurate j udgement of the morphologic features of the runoff arteries in their f ull length in patients with peripheral arterial occlusive disease.