COLOR DUPLEX SCANNING AND PULSE-GENERATED RUN-OFF FOR ASSESSMENT OF POPLITEAL AND CRUROPEDAL ARTERIES BEFORE PERIPHERAL BYPASS-SURGERY

Background This prospective pilot study compared the diagnostic accura cy of duplex scanning and pulse-generated run-off (PGR) with intra-art erial digital subtraction angiography (IADSA) for assessment of poplit eal, crural and pedal arteries, and explored the reliability of invest igation with the combination of duplex scanning and PGR in patients wh o needed femorodistal reconstruction. Methods In 23 limbs, 345 arteria l segments were graded independently with duplex scanning and IADSA as normal, stenosed or occluded and compared using weighted kappa analys is. PGR was rated as good, poor or no run-off and compared with pedal arch patency on IADSA. Based on information derived from duplex scanni ng and PGR a vascular surgeon proposed treatment and the distal anasto mosis site for bypass, which was compared with definitive treatment as determined by IADSA. Results Overall agreement between duplex scannin g and IADSA for popliteal and crural arteries was moderate (kappa 0.47 , 95 per cent confidence interval (c.i.) 0.39-0.55) with best agreemen t within the popliteal and proximal tibial arteries. Agreement within pedal arteries was fair (kappa 0.35, 95 per cent c.i. 0.17-0.53). PGR detected good run-off in five of 21 pedal arteries shown to be occlude d on IADSA. In 16 of 23 patients treatment based on duplex scanning an d PGR was identical to that based on IADSA. Eight of eleven femoropopl iteal bypasses were predicted accurately. Conclusion Operative strateg y could have been based on investigation by duplex scanning and PGR in a substantial number of patients scheduled for femoropopliteal bypass surgery. Agreement between duplex scanning and IADSA within very dist al arterial segments was fair.