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Wong TH, Tay KH, Sebastian MG, Tan SG
Correspondence: Dr Ting Hway Wong, wong.th@doctors.org.uk
ABSTRACT
Introduction The gold standard for evaluation of the lower extremity arterial tree is catheter angiography. Duplex arterial-occlusive imaging or duplex ultrasonography arteriography, a noninvasive technique, is used as the first-line investigation in patients with peripheral vascular disease at our centre. Based on the results of duplex imaging, patients who require angiographic intervention then proceed with simultaneous catheter arteriography and intervention. This study aimed to compare the results of duplex imaging alone as the first-line investigation against the eventual results of catheter angiography, and to assess the impact of the former on patients’ clinical outcomes.
Methods All cases involving patients who underwent duplex imaging followed by angiographic intervention, from May 2008 to February 2009, were discussed at weekly interdisciplinary meetings. Only patients who underwent lower limb imaging were included in the study. Those who were involved in grafts and stent surveillance studies, as well as those with incomplete duplex images were excluded.
Results During the study period, 113 duplex imaging studies of the lower limb followed by percutaneous transluminal angioplasty were performed at our hospital for peripheral vascular disease. The iliac artery was visualised in 40 images, but could not be visualised in 73 images. There was a potential change in management in three cases due to radiological differences between the duplex images and angiography films.
Conclusion In our series, duplex imaging was found to be accurate enough to guide initial clinical management of patients with peripheral vascular disease. This modality is the preferred first-line investigation for such patients at our centre.
Keywords: arterial-occlusive imaging, duplex ultrasonography, peripheral vascular disease
Singapore Med J 2013; 54(5): 271-274; http://dx.doi.org/10.11622/smedj.2013107
REFERENCES
| 1. Ascher E, Hingorani A, Markevich N, Schutzer R, Kallakuri S. Acute lower limb ischemia: the value of duplex ultrasound arterial mapping (DUAM) as the sole preoperative imaging technique. Ann Vasc Surg 2003; 17:284-9. http://dx.doi.org/10.1007/s10016-001-0263-9 | ||||
| 2. Ascher E, Mazzariol F, Hingorani A, Salles-Cunha S, Gade P. The use of duplex ultrasound arterial mapping as an alternative to conventional arteriography for primary and secondary infrapopliteal bypasses. Am J Surg 1999; 178:162-5. http://dx.doi.org/10.1016/S0002-9610(99)00151-8 | ||||
| 3. Collins R, Burch J, Cranny G, et al. Duplex ultrasonography, magnetic resonance angiography and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review. BMJ 2007; 334:1257-61. http://dx.doi.org/10.1136/bmj.39217.473275.55 | ||||
| 4. Ouwendijk R, de Vries M, Stijnen T, et al. Multicenter randomized controlled trial of the costs and effects of noninvasive diagnostic imaging in patients with peripheral arterial disease: the DIPAD trial. AJR Am J Roentgenol 2008; 190:1349-57. http://dx.doi.org/10.2214/AJR.07.3359 | ||||
| 5. Hingorani A, Ascher E, Marks N. Preprocedural imaging: new options to reduce need for contrast angiography. Semin Vasc Surg 2007; 20:15-28. http://dx.doi.org/10.1053/j.semvascsurg.2007.02.005 | ||||
| 6. Favaretto E, Pili C, Amato A, et al. Analysis of agreement between Duplex ultrasound scanning and arteriography in patients with lower limb artery disease. J Cardiovasc Med (Hagerstown) 2007; 8:337-41. http://dx.doi.org/10.2459/01.JCM.0000268124.51543.b2 | ||||
| 7. Hingorani AP, Ascher E, Marks N, et al. Limitations of and lessons learned from clinical experience of 1,020 duplex arteriography. Vascular 2008; 16:147-53. http://dx.doi.org/10.2310/6670.2008.00014 | ||||
| 8. Met R, Bipat S, Legemate DA, Reekers J A, Koelemay, MJ. Diagnostic Performance of Computed Tomography Angiography in Peripheral Arterial Disease: A Systematic Review and Meta-analysis. JAMA 2009; 301:415-24. http://dx.doi.org/10.1001/jama.301.4.415 | ||||
| 9. Bradbury AW, Adam DJ. Diagnosis of peripheral arterial disease of the lower limb. BMJ 2007; 334:1229-30. http://dx.doi.org/10.1136/bmj.39244.344664.80 | ||||