Document Detail


Lower extremity arterial evaluation: are segmental arterial blood pressures worthwhile?
MedLine Citation:
PMID:  9620134     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Physiologic observations with blood flow waveform analysis and pressure measurements can document the severity of lower extremity arterial disease. Segmental blood pressures (SEGPs) taken at the thigh, calf, and ankle are commonly used, but their utility has seldom been studied. We quantified improvements in accuracy compared with arteriography when ankle pressures alone (ABI) or SEGP data were added to velocity waveforms obtained by Doppler ultrasound.
METHODS: Continuous-wave Doppler velocity waveforms were recorded at common femoral (CFA), popliteal (POP), and dorsal pedal and posterior tibial (TIB) arterial levels. Systolic SEGP data were obtained with appropriately sized upper thigh, upper calf, and ankle cuffs. Waveforms, waveforms plus ABI, and waveforms plus SEGP data from 81 patients were randomly interpreted by 14 technologists or physicians from four institutions blinded to clinical and arteriographic data. Arteriograms were assigned negative or significant, severe (>75% diameter stenosis) values for four segments: iliofemoral (CFA), superficial femoral (SFA), popliteal (POP), and infrapopliteal (TIB) arteries. A total of 9072 segmental interpretations were analyzed.
RESULTS: Compared with arteriography, the accuracy of waveform analysis was 83% for severe disease at and proximal to the CFA, 79% for SFA disease, 64% for POP disease, and 73% for TIB disease. Adding ABI improved the accuracy significantly (p < 0.01) to 88% (CFA), 86% (SFA), 70% (POP), and 85% (TIB). Accuracy was inferior when SEGP data replaced ABI: 86% (CFA), 85% (SFA), 70% (POP), and 80% (TIB).
CONCLUSIONS: ABIs significantly improved Doppler waveform accuracy at all levels. Compared with ABI, the addition of segmental pressure to waveform data failed to improve accuracy. Pressure measurements above the ankle may lack cost effectiveness and clinical utility.
Authors:
S S Gale; R P Scissons; S X Salles-Cunha; S M Dosick; R C Whalen; J P Pigott; H G Beebe
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  27     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-06-29     Completed Date:  1998-06-29     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  831-8; discussion 838-9     Citation Subset:  IM    
Affiliation:
Jobst Vascular Center, Toledo, Ohio 43606, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angiography
Ankle / blood supply
Arteries / physiopathology,  ultrasonography
Blood Flow Velocity / physiology
Blood Pressure / physiology*
Constriction, Pathologic / physiopathology,  radiography,  ultrasonography
Female
Femoral Artery / physiopathology,  radiography,  ultrasonography
Foot / blood supply,  radiography,  ultrasonography
Humans
Iliac Artery / physiopathology,  radiography,  ultrasonography
Leg / blood supply*,  radiography,  ultrasonography
Male
Middle Aged
Peripheral Vascular Diseases / physiopathology,  radiography,  ultrasonography
Popliteal Artery / physiopathology,  radiography,  ultrasonography
Regional Blood Flow / physiology
Single-Blind Method
Systole
Thigh / blood supply
Tibial Arteries / physiopathology,  radiography,  ultrasonography
Ultrasonography, Doppler

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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