Value of duplex scanning in evaluation of crural and foot arteries in limbs with severe lower limb ischaemia--a prospective comparison with angiography.

OBJECTIVES

To compare Duplex scanning with angiography for evaluation of crural and pedal arteries in limbs with lower limb ischaemia.

DESIGN

The findings obtained during Duplex scanning and angiography were prospectively compared in a blinded manner.

SETTING

Departments of Surgery, Diagnostic Radiology and Clinical Physiology, University Hospital.

MATERIALS

Duplex scanning and selective angiography of femoropopliteal, crural and foot arteries were performed in 40 limbs (38 patients, 480 segments) with intermittent claudication (n = 6), rest pain (n = 13) and ulcer/gangrene (n = 19). Each arterial segment were graded into four categories: normal, < or = 50% diameter reduction, > 50% diameter reduction and occlusion. Pedal arteries were evaluated as patency or occlusion of dorsal pedal artery and plantar arch.

CHIEF OUTCOME MEASURES

Accuracy (AC), sensitivity (SE), specificity (SP), positive predictive (PPV), negative predictive (NPV) and kappa values.

MAIN RESULTS

The Duplex scanning of the tibioperoneal trunk, crural and pedal arteries had an accuracy of 80% (kappa = 0.6). The SE, SP, PPV and NPV values were 83%, 77%, 79% and 81%, respectively. The SP was relatively low for the peroneal artery (58%) compared to the others.

CONCLUSIONS

The results demonstrate the feasibility and reliability of Duplex scanning in detecting crural and pedal artery lesions in lower limbs with severe ischaemia.