IS ROUTINE PREOPERATIVE AORTOILIAC ARTERIOGRAPHY NECESSARY IN THE TREATMENT OF LOWER-EXTREMITY ISCHEMIA

Purpose: To determine whether preoperative aortoiliac arteriography ca n be replaced with noninvasive evaluation in the management of some pa tients with chronic lower extremity ischemia. Methods Preoperative eva luation was performed on 184 ischemic limbs (119 patients) over 19 mon ths by means of aortoiliac arteriography with runoff and noninvasive s tudies, which included common femoral artery duplex scanning, waveform and acceleration time (normal <140 msec), and aortoiliac duplex scann ing. An algorithm was proposed for combining indirect (common femoral artery evaluation) and direct (aortoiliac evaluation) noninvasive stud ies to decrease the need for aortoiliac arteriography when possible. R esults: Aortoiliac occlusive disease (greater than or equal to 50% ste nosis to occlusion) was present at arteriography in 48 limbs (30%), an d there was no inflow disease in 114 (70%). Aortoiliac lesions were id entified by means of noninvasive studies. The accuracies of femoral wa veform, acceleration time, and aortoiliac duplex studies were 85%, 89% and 87%. The negative predictive values were 92%, 94% and 100%. The a cceleration time results were not affected by runoff status but were s ignificantly different for various categories of stenosis (p < 0.05). The algorithm was applied to the data obtained. When acceleration time and waveform were normal, 84 of 86 patients (98%) had no stenosis at arteriography. When aortoiliac duplex findings mere normal, the arteri ographic findings were normal in all examinations. Conclusion: A combi nation of indirect and direct noninvasive studies can be used reliably to rule out clinically significant inflow occlusive disease and allow s selective nse of aortoiliac arteriography in patients with lower ext remity ischemia.