The Postexercise Common Femoral Artery Doppler Waveform: A Powerful Noninvasive Vascular Laboratory Test to Exclude Aortoiliac Disease

Abstract

Objective The detection of aortoiliac occlusive disease (AIOD) has important clinical implications for patients with peripheral arterial disease. The clinical utility of the common femoral artery (CFA) Doppler waveform (DW) at rest and after exercise in the detection of AIOD was investigated. Methods A retrospective review was performed of 203 consecutive exercise treadmill tests at Boston Medical Center from January 2006 to July 2009 that included both resting and postexercise CFA DW. The study population consisted of 62 patients (124 limbs) who had additional anatomical imaging studies, including computed tomography, magnetic resonance, or conventional angiography. Two blinded observers reviewed the CFA DW and imaging studies. Triphasic or biphasic CFA DW were considered normal. Monophasic CFA DW was considered abnormal. To determine test characteristics, resting and postexercise CFA DW were compared with the imaging findings. Similar analysis was performed for the ankle brachial index (ABI) for comparison. Results Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy (with 95% confidence interval) of the resting CFA DW in detecting a >50% aortoiliac stenosis were 29% (21–37%), 92% (87–97%), 31% (23–39%), 91% (86–96%), and 85% (79–91%), respectively. The results for the postexercise CFA DW in detecting a >50% aortoiliac stenosis were 93% (89–97%), 59% (50–68%), 22% (15–29%), 99% (97–100%), and 63% (55–71%), respectively. Resting CFA DW detected only 4 of 14 limbs with AIOD. Postexercise CFA DW markedly increased the detection of AIOD: 9 limbs with normal resting CFA DW were correctly diagnosed on the basis of postexercise CFA DW for a total of 13 of 14 limbs with AIOD. In addition, postexercise change in ABI was analyzed and only detected 9 of the 14 limbs with AIOD. Conclusions These findings support the use of postexercise CFA DW to enhance the evaluation of clinically important AIOD. The sensitivity of the test to detect AIOD was improved compared with resting CFA DW or postexercise drop in ABI. Normal postexercise CFA DW has high predictive value in excluding significant inflow disease.

Diagnostic Accuracy of Ankle-Brachial Pressure Index Compared with Doppler Arterial Waveforms for Detecting Peripheral Arterial Disease: A Systematic Review

“…Thus, ABPI may be a better diagnostic test because it provides fewer false positive errors. 24 The lower specificity of DAWs may be attributable to a combination of factors, including different classifications of abnormal waveforms 16,28,29 and operator variability. 17,30 A previously published review highlighted inadequate definitions to characterize DAWs and a lack of consensus leading to decreased standardization of DAWs and inappropriate testing.…”

“…Thus, ABPI may be a better diagnostic test because it provides fewer false positive errors 24 . The lower specificity of DAWs may be attributable to a combination of factors, including different classifications of abnormal waveforms 16,28,29 and operator variability 17,30 …”