The Use of Segmental Femoropopliteal Duplex Scanning for Initial Vascular Laboratory Testing of Patients with Peripheral Arterial Disease

Abstract

Introduction —Segmental femoropopliteal duplex scanning in conjunction with ankle plethysmographic waveforms and ankle/brachial indices (ABI) was evaluated as an alternative to traditional physiologic testing for the initial vascular laboratory evaluation of patients with lower extremity peripheral arterial disease (PAD). To assess the potential of this evaluation, patients with PAD were evaluated in the vascular laboratory with (1) pulse volume recording and segmental pressures (SPVR) and (2) femoropopliteal duplex imaging with pulsed Doppler waveform analysis and bilateral ankle plethysmographic waveforms and ABI (SDuplex). Methods. —SPVR and SDuplex data were prospectively obtained from 39 patients and 72 limbs. Separate technologists performed the physiologic and duplex examinations independently. Angiograms performed within 90 days were used as the gold standard for evaluating results from both procedures. Results from both examinations were interpreted for severe (>50% diameter reduction) inflow and superior femoral artery (SFA) disease. A McNemar test was performed on the SPVR and SDuplex paired data, and direct (hands-on) examination time was calculated for both procedures. Results. —Angiograms were available for 20 of 72 (28%) of the limbs evaluated and demonstrated no significant differences between both methods for evaluating inflow (femoral or above) disease, yet SDuplex was superior to SPVR for evaluating SFA disease. McNemar test data also suggested that SDuplex was superior to SPVR in diagnosing severe disease at the SFA level. The average time for SPVR examination performance was 28 minutes and 31 minutes for SDuplex with ABI and ankle waveforms. Conclusions. —SDuplex was superior to SPVR for evaluating SFA disease. No noteworthy differences in direct (hands-on) examination times for both procedures suggest the additional benefit of enhanced reimbursement. With superior SFA accuracy, more site-specific information, and greater reimbursement potential, SDuplex should be considered an alternative to the traditional physiologic examination for evaluating patients with lower extremity PAD.

Comparison of Subjective versus Objective Lower-Extremity Arterial Plethysmographic Waveform Analysis for the Identification of Hemodynamically Significant Inflow Disease

“…1,3,8 Thigh pressures, both single and multilevel, have been used to help differentiate INFLOW from SFA disease with confl icting results. 1,3,11,14,15 In this study, using brachial to thigh cuff pressure differences of 0-19 mmHg or >20 mmHg were equally poor in differentiating INFLOW from SFA disease and supports previous observations on the interpretive contribution and clinical utility of segmental pressure measurements. [13][14][15] Our initial investigation of objective waveform characteristics excluded patients with diabetes.…”

“…1,3,11,14,15 In this study, using brachial to thigh cuff pressure differences of 0-19 mmHg or >20 mmHg were equally poor in differentiating INFLOW from SFA disease and supports previous observations on the interpretive contribution and clinical utility of segmental pressure measurements. [13][14][15] Our initial investigation of objective waveform characteristics excluded patients with diabetes. 9 APW parameters in this study were limited to TIME, CURV, and RAR and included a borderline interpretation zone that varied the negative and positive predictive value, depending on the preference of the interpreter.…”