The role of duplex scanning in the selection of patients with critical lower-limb ischemia for infrainguinal percutaneous transluminal angioplasty

Purpose: To investigate the role of duplex scanning in the selection of pat ients with critical lower-limb ischemia (CLI) for infrainguinal. percutaneo us. transluminal angioplasty (PTA). Methods: One hundred and sixty-two limbs with CLI (150 patients) that under went duplex scanning within 3 months prior to conventional diagnostic angio graphy (n = 88) or infrainguinal PTA (n = 74) were retrospectively studied. The findings obtained from duplex scanning and angiography were analyzed i n a masked fashion by two different investigators. Results: The accuracy, sensitivity, specificity, and negative and positive predictive values of duplex scanning, in the selection Of patients for infr ainguinal PTA were 86%, 84%, 89%, 86%, and 87% respectively. Forty-two proc edures (57%) were performed at multiple arterial segments. The accuracy of duplex scanning in the selection of femoropopliteal and crural lesions for PTA was over 85%. However, the sensitivity of duplex scanning in the select ion of popliteal and crural lesions for PTA was 49% and 38% respectively, c ompared with 80% for superior femoral artery lesions. In 39% of patients wh o were correctly selected for PTA, duplex scanning misdiagnosed one of the multiple lesions treated by PTA. Conclusion: Duplex scanning can safely be used for the selection of patient s for infrainguinal PTA. The sensitivity of duplex scanning in the selectio n of lesions for PTA was less satisfactory in the popliteal and crural arte ries compared with the femoropopliteal arteries.