Colour-coded duplex imaging and dependent Doppler ultrasonography in the assessment of cruropedal vessels

Background: It has been suggested that ultrasonography could replace diagno stic arteriography in the assessment of patients who present with leg ischa emia. This study investigated a group of consecutive patients who had femor odistal bypass and who were assessed before operation with colour-coded dup lex and dependent Doppler insonation alone. Methods: Thirty-seven consecutive patients with critical lower limb ischaem ia underwent surgical exploration with a view to femorodistal bypass. Results of preoperative colour-coded duplex and dependent Doppler insonatio n were compared with intraoperative arteriograms and surgical findings. Res ults: There was very good agreement between colour-coded duplex imaging and dependent Doppler insonation with intraoperative angiography and surgical findings in the prediction of the optimal run-off vessel (kappa = 1.0) and the site of the distal anastomosis (kappa = 0.85; 95 per cent confidence in terval 0.71-1.0). There was also very good agreement between dependent Dopp ler insonation and intraoperative arteriography (kappa = 1.0) in predicting pedal arch patency and the predominant feeding vessel. Conclusion: Assessment of leg arteries before femorodistal bypass can be pe rformed accurately with non-invasive colour-coded duplex imaging and depend ent Doppler insonation alone, thus obviating the need for preoperative arte riography.