Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain.
Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain.
Ann Vasc Surg. 2021 May;73:205-210. doi: 10.1016/j.avsg.2020.10.027. Epub 2020 Nov 26.
The aim of this study was to analyze duplex ultrasound (DUS) and intraoperative angiography concordance for diagnosis of lower limb peripheral artery disease and its value for surgical planning.
This was a prospective, observational study, including patients who underwent revascularization of the lower limbs during 2018, diagnosed by DUS only or combined with preoperative computed tomography (CT) angiography. The concordance between preoperative DUS or CT angiography and the intraoperative angiography was studied using the Cohen kappa coefficient (k). The degree of agreement between the DUS-based surgical plan and the final surgical technique was also evaluated.
Fifty-one patients were included, with mean age of 71.8 ± 11.96 years (46-94); 23 had chronic kidney disease (45%). In 17 patients (34%), preoperative CT angiography was also performed. DUS showed a sensitivity of 100% (95% confidence interval (CI) [83.3-100%]), 80% (95% CI [50.21-100%,]), and 100% (95% CI [96.43-100%]) at the iliac, femoral, and popliteal sector, respectively, and a specificity of 93.55% (95% CI [83.29-100%]), 95.45% (95% CI [84.48-100%]), and 90.48% (95% CI [75.54-100%]) at the iliac, femoral, and popliteal sector, respectively. The positive predictive value for DUS was 60% (95% CI [7.06-100%]), 88.9% (95% CI [62.8-100%]), and 87.5% (95% CI [68.17-100%]) for the iliac, femoral, and popliteal sectors, respectively, whereas the negative predictive value was 100% (95% CI [98.28-100%]), 91.3% (95% CI [77.61-100%]), and 100% (95% CI, [97.37-100%]). The concordance between DUS and intraoperative angiography showed a k index of 0.587 (P = 0.000) in the iliac sector, 0.799 in the femoral sector (P = 0.000), and 0.699 in the popliteal sector (P = 0.000). The concordance between CT angiography/intraoperative angiography had a k index of 0.71 in the iliac sector (P = 0.0093), 0.566 in the femoral sector (P = 0.006), and 0.5 in the popliteal sector (P = 0.028). DUS-based surgical plan was accurate in 86% of cases (n = 44).
Our experience suggests that DUS arterial mapping of the femoral and popliteal areas is better than CT angiography and can be considered as a unique preoperative imaging test during the surgical planning in patients undergoing a lower limb revascularization procedure.
本研究旨在分析下肢周围动脉疾病的双功能超声（DUS）和术中血管造影的一致性，并评估其对手术计划的价值。
这是一项前瞻性、观察性研究，纳入了 2018 年接受下肢血运重建术的患者，这些患者仅通过 DUS 或术前计算机断层血管造影（CTA）进行诊断。采用 Cohen kappa 系数（k）研究术前 DUS 或 CTA 与术中血管造影的一致性。还评估了基于 DUS 的手术计划与最终手术技术之间的一致性。
共纳入 51 例患者，平均年龄为 71.8±11.96 岁（46-94 岁）；23 例患有慢性肾脏病（45%）。17 例患者（34%）术前还进行了 CTA。DUS 在髂、股和腘动脉节段的敏感性分别为 100%（95%可信区间 [83.3-100%]）、80%（95%可信区间 [50.21-100%]）和 100%（95%可信区间 [96.43-100%]），特异性分别为 93.55%（95%可信区间 [83.29-100%]）、95.45%（95%可信区间 [84.48-100%]）和 90.48%（95%可信区间 [75.54-100%]）。DUS 的阳性预测值在髂、股和腘动脉节段分别为 60%（95%可信区间 [7.06-100%]）、88.9%（95%可信区间 [62.8-100%]）和 87.5%（95%可信区间 [68.17-100%]），阴性预测值为 100%（95%可信区间 [98.28-100%]）、91.3%（95%可信区间 [77.61-100%]）和 100%（95%可信区间 [97.37-100%]）。DUS 与术中血管造影的一致性 k 指数在髂动脉节段为 0.587（P=0.000），在股动脉节段为 0.799（P=0.000），在腘动脉节段为 0.699（P=0.000）。CTA/术中血管造影的一致性 k 指数在髂动脉节段为 0.71（P=0.0093），在股动脉节段为 0.566（P=0.006），在腘动脉节段为 0.5（P=0.028）。基于 DUS 的手术计划在 86%的病例（n=44）中是准确的。
我们的经验表明，股动脉和腘动脉区域的 DUS 动脉成像优于 CTA，可考虑作为下肢血运重建术患者手术计划的唯一术前影像学检查。
