CAN CRUROPEDAL COLOR DUPLEX SCANNING AND PULSE GENERATED RUN-OFF REPLACE ANGIOGRAPHY IN CANDIDATES FOR DISTAL BYPASS-SURGERY

Purpose: To compare the diagnostic accuracy of duplex scanning (DS) an d pulse generated run-off (PGR) with ia-DSA for the assessment of crur opedal outflow and explore the reliability of clinical decision making based on a work-up with DS/PGR in candidates for peripheral bypass su rgery. Methods: Popliteal, crural and pedal arteries were evaluated in dependently with DS and in-DSA in 126 limbs of 120 consecutive patient s for claudication (16%) or critical ischaemia (84%). Arterial segment s were graded with DS and ia-DSA as normal, stenosed, or occluded and compared using weighted kappa (kappa) analysis. PGR tons used to selec t the best crural artery for bypass. Proposed management based on DS/P GR and, if applicable, anastomosis site were compared to definitive tr eatment based on ia-DSA. Results: Overall agreement between DS and ia- DSA for popliteal and crural arteries was moderate (kappa 0.51, 95% CI 0.48-0.55) with good agreement within the popliteal (kappa 0.67) and anterior tibial (kappa 0.61) arteries. Agreement was moderate within t he pedal arterieds (kappa 0.32, 95% CI 0.24-0.40). In 74/126 (59%) lim bs proposed management with DS/PGR was identical to in-DSA. In 23/29 ( 79%) femoropopliteal and 15/37 (41%) femorocrural bypasses DS/PGR agre ed perfectly with ia-DSA with regard to acceptor artery and anastomosi s site. Conclusion: DS can accurately assess the popliteal and anterio r tibial arteries. In a substantial number of patients with severe low er limb ischaemia decisions for conservative management, PTA and femor opopliteal bypass can be based on a DS/PGR work-up.