Department of Vascular Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy.
Department of Vascular Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy -
Int Angiol. 2021 Aug;40(4):306-314. doi: 10.23736/S0392-9590.21.04524-7. Epub 2021 Apr 9.
The aim of this work was to compare the diagnostic accuracy of Duplex ultrasound (DUS) and CT angiography (CTA) in the study of arterial vessels, in patients with chronic peripheral arterial disease (PAD) of the lower limbs to undergo endovascular revascularization with the use of intraprocedural digital angiography (DSA).
Ninety-four patients with obstructive pathology of the arterial axes of the lower limbs were enrolled in the study. In all patients, endovascular revascularization treatment was considered the most suitable therapeutic choice. For this reason, ultrasound and CTA was performed preoperatively in all and based on the data obtained it was decided to classify the arterial tree into five segments: iliac, common femoral, superficial femoral, popliteal and infra-geniculate. According to the degree of stenosis or occlusion, the arteries were scored in no stenotic, stenotic and occluded. The comparison of the data provided by the DUS and the CTA was carried out with reference to the parameters obtained by the DSA.
The results of our experience have shown that in the iliac arterial district DUS proved to be less accurate than CT angiography when compared to DSA (Cohen's κ agreement of 0.91 and 1.0, respectively). Good diagnostic concordance was found in the femoro-popliteal district (Cohen's κ agreement 33 between 0.96 and 0.93). On the contrary, when the data of the infra-geniculate area were compared, CT angiography showed a net deficiency compared to DSA and DUS (Cohen's κ: 0.75).
Due to its accuracy, high-quality DUS performed by well-trained operators may therefore represent a good alternative to CTA in patients undergoing endovascular revascularization, in order to reduce the use of contrast-enhanced radiological imaging especially when a condition of intolerance to the contrast medium and/or renal insufficiency coexists.
本研究旨在比较下肢慢性周围动脉疾病（PAD）患者血管腔内血管重建术时，使用术中数字血管造影（DSA）的情况下，双功能超声（DUS）和 CT 血管造影（CTA）对动脉血管的诊断准确性。
共纳入 94 例下肢动脉轴阻塞性病变患者。所有患者均考虑腔内血管重建治疗为最适合的治疗选择。为此，所有患者均进行了术前超声和 CTA 检查，并根据获得的数据将动脉树分为五个节段：髂动脉、股总动脉、股浅动脉、腘动脉和膝下动脉。根据狭窄或闭塞程度，将动脉分为无狭窄、狭窄和闭塞。将 DUS 和 CTA 提供的数据与 DSA 获得的参数进行比较。
我们的经验结果表明，在髂动脉区，DUS 与 CTA 相比，与 DSA 相比，其准确性较低（Cohen's κ 一致性分别为 0.91 和 1.0）。在股-腘动脉区发现良好的诊断一致性（Cohen's κ 一致性为 0.96 至 0.93 之间）。相反，当比较膝下区域的数据时，与 DSA 和 DUS 相比，CTA 显示出明显的不足（Cohen's κ：0.75）。
由于其准确性，经过良好培训的操作人员进行的高质量 DUS 可能是血管内血管重建术患者替代 CTA 的良好选择，以减少对比增强放射影像学的使用，特别是当存在对比剂不耐受和/或肾功能不全的情况下。
