Reliability of common femoral artery hemodynamics in assessing the severity of aortoiliac inflow disease.

OBJECTIVES

We investigated the utility of color duplex ultrasound (CDU)-derived common femoral artery (CFA) hemodynamics for detecting significant aortoiliac occlusive disease and predicting its severity.

METHODS

From January 1997 to June 2001, 132 consecutive patients with lower extremity arterial insufficiency underwent both femoropopliteal CDU scanning and aortography with runoff studies. CDU-derived CFA waveform contour (monophasic, biphasic, or triphasic), peak systolic velocity (PSV), and acceleration time were recorded for each patient. Severity of aortoiliac occlusive disease was classified by arteriography into three distinct groups: normal or minimal disease (<50%, group 1), significant focal or diffuse stenoses (>/=50%, group 2), or total occlusion (group 3). Using probability and receiver operating characteristic curve analysis, waveform contour and PSV were compared alone and in combination with the arteriographic groups to identify waveform contours and threshold PSV, which may accurately differentiate the three categories of aortoiliac occlusive disease.

RESULTS

Of 214 limbs available for study, 112 composed group 1, 70 composed group 2, and 32 composed group 3. Concomitant femoropopliteal disease was present in 47% of limbs in group 1, 53% of limbs in group 2, and 34% of limbs in group III. An abnormal CFA waveform contour (monophasic or biphasic) differentiated group 1 from groups 2 and 3, with 95% sensitivity, 89% specificity, 89% positive predictive value (PPV), 95% negative predictive value (NPV), and 92% accuracy. Mean PSV and acceleration time for monophasic and biphasic waveforms were 39 cm/sec +/- 19, 178 msec +/- 36 vs 95 cm/sec +/- 67, 97 msec +/- 31 respectively (P <.05). In differentiating between groups 2 and 3, the specificity, PPV, and accuracy for CFA PSV of </=45 cm/sec alone and for the PSV </=45 cm/sec combined with a CFA monophasic waveform were 89%, 76%, 85% and 97%, 92%, 88%, respectively. Concomitant significant superior femoral artery and bilateral iliac disease did not influence these findings.

CONCLUSION

CFA PSV 45 cm/s or less combined with a monophasic waveform is highly predictive of ipsilateral iliac occlusion. These results were independent of contralateral iliac and distal superior femoral artery disease. CFA color duplex US scanning may be considered an alternative technique to direct duplex scanning of the aortoiliac segment in patients being evaluated for inflow endoluminal or bypass procedures.