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Can duplex arterial ultrasonography reduce unnecessary angiography?

Elgzyri, T LU ; Ekberg, G; Peterson, K LU ; Lundell, A LU and Apelqvist, J LU (2008) In Journal of Wound Care 17(11). p.497-500
Abstract

OBJECTIVE: To assess the value of arterial duplex ultrasound, which assesses the location and severity of arterial disease, in determining whether invasive vascular intervention is required.

METHOD: A total of 166 consecutive diabetic patients presenting at a multidisciplinary foot clinic with severe peripheral vascular disease, with or without a foot ulcer, were included in this prospective study. The choice of vascular intervention was based on the results of a duplex ultrasound examination. Subjects were followed up for two years, and their clinical management, vascular assessments and interventions given, and patient outcomes were recorded in a specially designed protocol.

RESULTS: Based on findings of the duplex... (More)

OBJECTIVE: To assess the value of arterial duplex ultrasound, which assesses the location and severity of arterial disease, in determining whether invasive vascular intervention is required.

METHOD: A total of 166 consecutive diabetic patients presenting at a multidisciplinary foot clinic with severe peripheral vascular disease, with or without a foot ulcer, were included in this prospective study. The choice of vascular intervention was based on the results of a duplex ultrasound examination. Subjects were followed up for two years, and their clinical management, vascular assessments and interventions given, and patient outcomes were recorded in a specially designed protocol.

RESULTS: Based on findings of the duplex ultrasound, it was recommended that 55 patients (33%) should undergo angioplasty (percutaneous transluminal angioplasty [PTA] and/or subintimal recanalisation), 64 patients (39%) diagnostic angiography and 47 patients (28%) medical treatment only, thereby avoiding unnecessary angiography and its potential complications. Diagnostic angiography was recommended when the duplex ultrasound results were inconclusive. Fifty-two of the 55 patients recommended angiography with simultaneous angioplasty had an angiography; of these, 42 (81%) then had an angioplasty. Fifty-seven of the 64 patients with inconclusive results had an angiography. Of these, 23 (40%) subsequently had angioplasty, only 10 (18%) had reconstructive surgery and 24 (42%) had a diagnostic angiography only.

CONCLUSION: Arterial duplex ultrasound may assist evaluations of the need for and type of invasive vascular intervention in patients with an ischaemic diabetic foot. It can thus help avoid diagnostic angiographies that do not result in vascular intervention. However, such decision-making remains at the discretion of the vascular surgeon and radiologist.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Angiography, Arteries/diagnostic imaging, Decision Trees, Humans, Peripheral Vascular Diseases/diagnostic imaging, Ultrasonography, Doppler
in
Journal of Wound Care
volume
17
issue
11
pages
4 pages
publisher
Emap Healthcare Limited
external identifiers
  • scopus:63149198961
ISSN
0969-0700
DOI
10.12968/jowc.2008.17.11.31478
language
English
LU publication?
yes
id
6f748729-3b53-411a-a021-876074df0c2e
date added to LUP
2019-02-02 13:44:03
date last changed
2019-09-04 04:37:44
@article{6f748729-3b53-411a-a021-876074df0c2e,
  abstract     = {<p>OBJECTIVE: To assess the value of arterial duplex ultrasound, which assesses the location and severity of arterial disease, in determining whether invasive vascular intervention is required.</p><p>METHOD: A total of 166 consecutive diabetic patients presenting at a multidisciplinary foot clinic with severe peripheral vascular disease, with or without a foot ulcer, were included in this prospective study. The choice of vascular intervention was based on the results of a duplex ultrasound examination. Subjects were followed up for two years, and their clinical management, vascular assessments and interventions given, and patient outcomes were recorded in a specially designed protocol.</p><p>RESULTS: Based on findings of the duplex ultrasound, it was recommended that 55 patients (33%) should undergo angioplasty (percutaneous transluminal angioplasty [PTA] and/or subintimal recanalisation), 64 patients (39%) diagnostic angiography and 47 patients (28%) medical treatment only, thereby avoiding unnecessary angiography and its potential complications. Diagnostic angiography was recommended when the duplex ultrasound results were inconclusive. Fifty-two of the 55 patients recommended angiography with simultaneous angioplasty had an angiography; of these, 42 (81%) then had an angioplasty. Fifty-seven of the 64 patients with inconclusive results had an angiography. Of these, 23 (40%) subsequently had angioplasty, only 10 (18%) had reconstructive surgery and 24 (42%) had a diagnostic angiography only.</p><p>CONCLUSION: Arterial duplex ultrasound may assist evaluations of the need for and type of invasive vascular intervention in patients with an ischaemic diabetic foot. It can thus help avoid diagnostic angiographies that do not result in vascular intervention. However, such decision-making remains at the discretion of the vascular surgeon and radiologist.</p>},
  author       = {Elgzyri, T and Ekberg, G and Peterson, K and Lundell, A and Apelqvist, J},
  issn         = {0969-0700},
  keyword      = {Angiography,Arteries/diagnostic imaging,Decision Trees,Humans,Peripheral Vascular Diseases/diagnostic imaging,Ultrasonography, Doppler},
  language     = {eng},
  number       = {11},
  pages        = {497--500},
  publisher    = {Emap Healthcare Limited},
  series       = {Journal of Wound Care},
  title        = {Can duplex arterial ultrasonography reduce unnecessary angiography?},
  url          = {http://dx.doi.org/10.12968/jowc.2008.17.11.31478},
  volume       = {17},
  year         = {2008},
}