Duplex scanning allows selective use of arteriography in the management ofpatients with severe lower leg arterial disease

Purpose: Until April 1997 we routinely performed intra-arterial digital sub traction angiography (iaDSA) in all patients with severe lower leg ischemia requiring intervention. After a comparative study of duplex scanning (DS), pulse-generated runoff, and iaDSA of the lower leg arteries, we postulated that management could be based on DS/pulse-generated runoff in 59% of pati ents. We prospectively evaluated the safety of such a noninvasive workup, s trategy. Methods. All consecutive patients referred with severe lower leg ischemia b etween April 1997 and September 1998 were eligible. Management was based on DS with iaDSA being performed only on indication. Complications within 30 days and 12- and 24-month patency, survival, and limb salvage rates were re corded and compared with historical controls. Results: A total of 125 limbs in 114 patients were evaluated (74% rest pain or tissue loss). In 97 (78%) of 125 limbs, management was based on DS. It comprised conservative treatment (n=33, 0% after iaDSA), percutaneous trans luminal angioplasty (n=25, 16% iaDSA), femoropopliteal bypass graft (n=29, 17% iaDSA), femorotibial bypass graft (n=29, 62% iaDSA), and other surgical procedures (n=8, 4% iaDSA). Overall, the mortality within 30 days was 4% ( 5/114), and 2-year survival was 83%. Two-year primary and secondary patency and limb salvage rates were 75%, 93%, and 93% after a femoropopliteal bypa ss operation, respectively. One-year primary and secondary patency and limb salvage rates were 35%, 73%, and 74%, respectively, after a femorocrural b ypass operation. There were no differences in patient characteristics, indi cation for specific treatment, and immediate and intermediate term outcome between the study and reference population. Conclusion: In a vascular unit with wide expertise in DS of the lower leg a rteries, management of patients with severe lower leg ischemia can be based on DS in most patients without negative effects on clinical outcome within 30 days and at 2-years' follow-up.