THE APPROPRIATE USE OF THE DUPLEX SCAN IN CAROTID ARTERIAL-DISEASE

The duplex scan has become the definitive test in the diagnosis of car otid arterial disease. Pts significance, however, has been diminished its extensive use for inappropriate indications, We performed a retros pective study over a four year period at two major hospitals to evalua te the different indications for carotid duplex scans, Symptoms which prompted the test, associated diseases, the type of physician ordering the test, and demographic data were recorded an all patients, Statist ical analysis was used to indicate which symptoms and associated disea ses were significant in predicting carotid disease. A told of 4,764 sc ans were reviewed, There were 4,289 studies (90%) which a were negativ e for disease requiring surgery. There were a total of PZ indications for the carotid duplex scape in this study; the most common indication s were dizziness, (20%) transient ischemic attack symptoms (19%) and a bruit (16%). Vascular surgeons (28%), internal Medicine physicians (2 7%) and Family practice physicians (15%) ordered the duplex scan most frequently, but 39% of the positive scans were ordered by vascular sur geons. A history of seizures, confusion, stroke and as a preoperative evaluation all had a very low yield and should not be used as an indic ation for a duplex scan. However, a long smoking history, a history of known carotid disease, and peripheral vascular disease all had a stat istical correlation with an abnormal duplex scan. The use of the duple x scan to rule out carotid arterial disease for patients with vague, u ncommon symptoms is inappropriate and wasteful.