A comparison of colour duplex ultrasonography, papaverine testing and common femoral Doppler waveform analysis for assessment of the aortoiliac arteries

Objective: to study the "accuracy" of aortoiliac colour duplex ultrasonogra phy. Design: prospective study. Setting: vascular laboratory, University Hospital. Methods: a total of 25 aortoiliac stenoses were studied in 23 patients. For each iliac segment, colour duplex ultrasound, papaverine testing, hyperaem ic common femoral Doppler waveform analysis and hyperaemic testing using a thigh pressure cuff were performed. A velocity ratio of two was used to ind icate a significant 50% diameter-reducing stenosis, but the velocity differ ences across stenoses as well as various characteristics of the hyyperaemic common femoral waveform were also studied. Retrospective receiver-operator characteristics and Kappa values were used for analysis. Results: the Kappa agreement between ultrasonography and papaverine testing was 0.12 using peak systolic velocity ratios and 0.8 using hyperaemic peak systolic velocity differences. Hyperaemic common femoral pulsatility (PI) and resistance index (RI) both gained a Kappa level of 0.60. The reactive h yperaemia produced by a thigh cuff was more pronounced than that produced b y papaverine. Conclusion: although the velocity ratio did not appear to perform well agai nst the papaverine test, its apparent over-sensitivity calls into question the sensitivity of papaverine testing itself. The hyperaemic velocity diffe rence at the stenosis or the hyperaemic PI or RI at common femoral level ap pear useful, non-intensive indicators of significant aortoiliac arterial di sease.