Diagnosis of Arterial Disease of the Lower Extremities with Duplex Ultrasonography

A prospective database included all patients who underwent lower extremity endovascular interventions between 2004 and 2009, and patients with de novo stenotic lesions in the femoropopliteal segment were selected. A study 1 analyzed duplex ultrasound (DUS) and digital subtraction angiography (DSA) data pairs HASH(0x2f830d0)30 days apart in 275 lesions (200 patients). Receiver operator characteristic (ROC) analysis showed that to detect HASH(0x2f82cc8)70% stenosis, a peak systolic velocity (PSV) of 200 cm/s had 89.2% sensitivity and 89.7% specificity, and a velocity ratio (Vr) of 2.0 had 88.7% sensitivity and 90.2% specificity. To differentiate between <50% and HASH(0x2f82cc8)50% stenosis, PSV of 150 cm/s and Vr of 1.5 were highly specific and predictive. Combining PSV 200 cm/s and Vr 2.0 for HASH(0x2f82cc8)70% stenosis gave 79.0% sensitivity, 99.0% specificity, 99.0% positive predictive value, and 85.0% negative predictive value.

A systematic review 2 included 14 studies. Of these 7 assessed the aortoiliac segment, 12 the femoropopliteal segment, and 3 the infragenicular segment.

For the aortoiliac segment, the sensitivity for the detection of greater or equal to 50% stenosis was 80% (95% CI 61% to 93%), and specificity 95% (95% CI 91% to 98%).

For the femoropopliteal segment, the sensitivity for the detection of greater or equal to 50% stenosis was 82% (95% CI 67% to 92%), and specificity 96% (95% CI 93% to 98%).

The sensitivities and specificities for detecting total occlusion in the aortoiliac and femoropopliteal segment were even better than those for the detection of at least 50% stenosis.

For the infragenicular segment, the sensitivity for the detection of occlusion or greater or equal to 50% stenosis was 83% (95% CI 59% to 96%), and specificity 84% (95% CI 69% to 93%).

Comment: The quality of evidence is upgraded by high quality of some original studies and the review.

References

• Khan SZ, Khan MA, Bradley B et al. Utility of duplex ultrasound in detecting and grading de novo femoropopliteal lesions. J Vasc Surg 2011;54(4):1067-73. [PubMed]
• Koelemay MJ, den Hartog D, Prins MH, Kromhout JG, Legemate DA, Jacobs MJ. Diagnosis of arterial disease of the lower extremities with duplex ultrasonography. Br J Surg 1996 Mar;83(3):404-9. [PubMed]