Accuracy of duplex scan in the management of chronic leg ischaemia

Arteriography is considered to be the standard investigation for peripheral arterial diseases. It gives an accurate anatomical description of obstructive arterial lesions. However, it does not estimate the haemodynamic significane of such lesions. Recently, advances in duplex scan have raised the possibility that it could replace arteriography as the primary imaging modality for assessment of limb ischemia. The aim of this study was to determine the rate of duplex scanning compared with arteriography in diagnosis of stenosis and occlusion in the peripheral arterial tree and to compare the management plan made on the basis of duplex scanning with that made on the basis of arteriography. Fifty one legs of 44 patients were studied prospectively. They were presented to the Vascular Division in KKUH between August 2001 to February 2003. Arteriography and duplex scanning were performed for each patient. Seven arterial segments were studied in each leg by measuring the peak systolic velocity at the arterial lesion. The data of duplex scanning were compared with arteriography performed which was used as the gold standard. In comparison with arteriography, sensitivity, specificity and accuracy of duplex scanning to assess obstructive arterial lesions were 93.5%, 97.6% and 94.9% respectively. Concerning the management plan, accuracy of decision making based on duplex scanning [94%] correlated well with that based on arteriography [100%]. Duplex scanning, in comparison to arteriography is a non-invasive investigation for rectifying obstructive arterial lesions, with a high sensitivity and specifity. A sound decision could be made according to the results of duplex scanning

Ultrasound guided compression repair of post-catheterization femoral pseudo-aneurysm

Iatrogenic pseudoaneurysm have traditionally been treated surgically Recently, this problem has been successfully treated without operation by the ultrasound-guided compression [UGC]. The purpose of this study is to describe the indications, technique and results for UGC of femoral pseudoaneurysms and to define the factors that predict its success. One hundred and two [102] patients were referred to the vascular division with suspected pseudoaneurysm [PA] over a 36 months period. Data regarding the location and morphologic characteristics of the pseudoaneurysms, anticoagulation status and morbid diseases were documented. Each pseudoaneurysm was compressed with a 4-7 MHz linear transducer for 10-minute intervals until the PA was completely occluded or the procedure was considered to be a failure. Out of 102 patients referred with suspected PA, 36 had a duplex confirmed PA [22 post cardiac catheterization, 10 postaortogram and four post femoral central line]. UCG was successful in 29 patients [81%], the rest were surgically treated. UGC provides a reliable alternative to surgical treatment for post catheterization femoral pseudoaneurysm. Anticoagulants, large PAsize [> 6 cm] and hypertension were main preditors for UGC failure

Accuracy of fine needle aspiration and frozen section in the management of thyroid nodules

Aim: To determine the accuracy of fine needle aspiration [FNA] and frozen section [F.S.] in the management of thyroid nodules. The medical records of 85 patients who underwent thyroidectomy were retrospective l y analyzed. FNA and F.S. were performed on all patients and their results were compared with definitive histological assessment. Setting: Study was undertaken at the King Khalid University Hospital during the period from January 1996 to 1999. Among the 85 patients who were submitted for FNA cytology, 53 patients were diagnosed as benign, 13 patients as malignant and 19 were indeterminate. The incidence of malignancy in the indeterminate group was 19%. The diagnosis from the frozen sections was benign in 59 cases [68.8%], malignant in 13 cases and deferred in 13 cases. Diagnostic accuracy up to 98% was achieved when FNA cytology and frozen section diagnoses agreed. No false positives were observed when FNA cytology and F.S. were positive for malignancy. When FNA cytology and F.S. diagnoses were discordant, F.S. showed a higher accuracy [100%] than FNA cytology. In the face of an indeterminate cytological diagnosis, the diagnostic accuracy of F.S. reached 100% with exclusion of the deferred group. Conclusions: FNA is an accurate preoperative tool for the initial evaluation of thyroid nodules. F.S. is a valuable test for confirming the FNA results and is more accurate than FNA in cases of discordant diagnosis