| Lower extremity arterial evaluation: are segmental arterial blood pressures worthwhile? | |
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MedLine Citation:
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PMID: 9620134 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial |
Journal Detail:
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Title: Journal of vascular surgery Volume: 27 ISSN: 0741-5214 ISO Abbreviation: J. Vasc. Surg. Publication Date: 1998 May |
Date Detail:
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Created Date: 1998-06-29 Completed Date: 1998-06-29 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 831-8; discussion 838-9 Citation Subset: IM |
Affiliation:
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Jobst Vascular Center, Toledo, Ohio 43606, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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