The Accuracy of Arterial Waveform Analysis in Predicting Arterial Lesions Diagnosed by CT Angiography in Symptomatic Patients

PURPOSE: CT angiography (CTA) is established as a standard method for the evaluation of patients with peripheral arterial disease. However, there are some drawbacks including overestimation of stenotic lesions as well as dye toxicity and allergic reactions and renal function impairment. Arterial waveform analysis (AWA) is widely accepted as a diagnostic as well as a screening tool in the vascular laboratory. The purpose of this study was to determine the diagnostic accuracy of the AWA compared to the CTA. METHOD: One hundred thirty-eight AWA procedures were performed among symptomatic patients in our laboratory between October 2004 and February 2007. Sixty patients were entered into the study; they were eligible to have AWA and CTA synchronously. There were 5 women and 55 men with an average age of 64 years. The disease entities were atherosclerosis in 53, Burger's disease in three, popliteal entrapment in 2, arterial embolism in 1 and vascular trauma in one. Continuous-wave Doppler velocity waveforms were recorded at the common femoral, popliteal and dorsal pedal and posterior tibial arterial levels with compression cuffs. Four hundred and eighty segmental interpretations were analyzed and compared with the CTA findings. RESULT: The sensitivity of the AWA to detect iliac, femoropopliteal and tibial lesions were 93.8%, 64.4% and 88.4% respectively. The specificity of the AWA for the iliac, femoropopliteal and tibial lesions were 87.3%, 93.4% and 95.6% respectively. Overall, the accuracy of the AWA was 88.9% compared to the CT findings. Additional exercise AWA improved the results from 82.8 % to 88.6% for the overall sensitivity of the AWA. The 20 false positives included technical problems in 14 and reference errors (CTA) in six that were due to calcifications. There were 33 false negatives mostly from cases with stenosis and good collaterals. CONCLUSION: The results of this study showed that the AWA was a valuable method for the prediction of hemodynamically significant arterial lesions. The addition of highly skilled operators and a protocol including a high thigh cuff application might improve the accuracy of this diagnostic method.

The Pattern & Change of Venous Reflux in Primary Varicose Vein

PURPOSE: Venous reflux in primary varicose vein arises from the saphenofemoral junction (SFJ), and the saphenopopliteal junction (SPJ) and it can arise from the non-junctional great saphenous vein (GSV) tributaries and, the non-saphenous veins. Superficial venous surgery (SVS) is associated with a significant improvement in the lower leg venous hemodynamics. We performed a retrospective study to examine the prevalence of the reflux pattern in the primary varicose veins and, to observe any change of non-junctional GSV reflux. METHOD: From May 2004 to July 2005, 481 patients (766 limbs) were diagnosed with venous incompetence by performing a duplex ultrasound examination. A follow-up duplex ultrasound examination was performed for a group of non-junctional GSV reflux patients and for a group of patient having both superficial vein reflux and deep vein reflux. RESULT: The prevalence of SFJ reflux, SPJ reflux, below the knee GSV reflux with competent SFJ and, non saphenous vein reflux was 82%, 13%, 10% and, 4.5% respectively. In the patients with SVS who had deep vein reflux (DVR), DVR was absent in only on two patients (6%). Eight patients (9.1%) of the 88 primary varicose vein patients had asymptomatic left iliac vein obstruction detected by performing an ascending venogram during radiofrequency ablation (RFA). On the duplex findings after SVS, the reflux pattern of left deep venous system was not different from the right deep venous system. CONCLUSION: Varicose veins may occur in any vein, even if junctional reflux is predominant. Careful duplex ultrasound evaluation will delineate the changing pattern of venous reflux with/without SVS. Although superficial venous surgery must fit the patient's map, the results might be variable. Prospective studies are needed to analyze the dynamics of venous reflux after SVS.