Can ultrasound replace arteriography in the management of chronic arterialocclusive disease of the lower limb?

Objectives: to investigate whether colour duplex scanning can be used as th e sole diagnostic investigation prior to lower limb revascularisation. Patients and Methods: the results of angiography and duplex were compared i n 80 limbs (69 claudication, 11 critical limb ischaemia [CLI]) from tig pat ients. Results: excellent diagnostic agreement (kappa value 0.89, 95% CI 0.85-0.93 ) was achieved at the femeropopliteal segment. Agreement was good for the a orto-iliac segment (kappa value 0.69, 95% CI 0.61-0.77) and moderate for th e infrapopliteal segment (kappa value 0.59, 95% CI 0.55-0.63). Similarly, i n the decision-making process excellent agreement was achieved for the femo ropopliteal segment (kappa value 0.91, 95% CI 0.88-0.94), good for the aort oiliac segment (kappa value 0.62, 95% CI 0.56-0.68), and moderate for the i nfrapopliteal segment (kappa value 0.46, 95% CI 0.42-0.50). Duplex detected patent 12 tibial arteries in 10 limbs that were not opacified on arteriogr aphy. In four limbs duplex revealed significant disease in the above knee p opliteal artery that was missed on arteriography. Conclusions: treatment of femoropopliteal disease carl be based upon duplex alone in the great majority of cases. However, where there is disease in t he aortoiliac segment, or where infrapopliteal revascularisation is long co nsidered both duplex and angiography should be performed to maximise pre-op erative information.