The impact of duplex scanning in the management of chronic lower limb arterial disease
Abstract: In patients with chronic lower extremity ischemia in which endovascular or surgical intervention is considered non-invasive evaluation by duplex scanning provides important anatomical and hemodynamic information. The aim of this thesis was to evaluate the impact of duplex scanning in the selection of various therapeutic alternatives in limbs with lower extremity arterial insufficiency. During a 5-year period, the feasibility and safety of performing following interventions with the findings obtained solely from duplex scanning were evaluated: 1- endovascular intervention of the iliac (n=93) and the infrainguinal arteries (n=108); 2- surgical reconstructions in patients with aorto-iliac occlusive disease (n=44); 3- femoral artery endarterectomy (n=32) and infrainguinal bypass grafting (n=125); 4- redo surgery in limbs with patent infrainguinal bypass grafts (n=56). The accuracy of duplex scanning to appropriately categorise iliac and infrainguinal arterial lesions into suitable or unsuitable for endovascular intervention was 90 and 91%, respectively. Of 284 surgical reconstructions performed without angiography, there were no deviations from preoperatively planned surgical strategy in all but 4 patients. Cumulative life table primary assisted patency rates at 12 months after supraingainal, infrainguinal and redo bypass surgery were 86, 74 and 85 %, respectively. In conclusion, duplex scanning has an important impact on the selection of treatment modalities in patients with chronic lower limb arterial disease. Aorto-iliac and infrainguinal surgical and endovascular interventions can safely be planned and performed solely based upon duplex scan findings in patients with conclusive scans.
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