Accuracy of color Doppler flow mapping for evaluation of the severity of femoropopliteal arterial disease: a prospective study.

The usefulness of color Doppler flow mapping for estimating the severity of femoropopliteal lesions was compared with that of angiography in 35 patients (70 extremities). Sonography depicted significant (greater than 40% luminal narrowing) arterial lesions in 45 of 47 lower extremities in which such lesions were present (sensitivity, 0.96 [95% confidence limits; 0.86, 0.99]). The absence of significant segmental stenosis or occlusion was confirmed in 15 of the 23 normal extremities (specificity, 0.65 [0.45, 0.81]). Occlusions amenable to bypass surgery were correctly predicted in 25 of 26 (sensitivity, 0.96 [0.81, 0.99]) and were excluded in 41 of 44 extremities (specificity, 0.93 [0.82, 0.98]). Lesions amenable to angioplasty were detected in 16 of 21 instances, with overestimation of severity in three lesions that were judged suitable for bypass surgery; two lesions were missed. Preangiographic screening with color Doppler flow mapping is an accurate method for predicting the presence of femoropopliteal artery occlusions amenable to bypass surgery. It is also a sensitive method for predicting the presence of peripheral arterial disease.

Determination of the extent of lower-extremity peripheral arterial disease with color-assisted duplex sonography: comparison with angiography.

Color-assisted duplex sonography combines color Doppler flow imaging with duplex sonography to rapidly survey the vasculature. Color Doppler sonography displays the motion of flowing blood on a sonogram and is used to visualize directly arterial lumen narrowing of greater than 50%. Absence of Doppler signals signifies arterial occlusion. Preangiographic triage of patients for surgical or interventional therapy requires that a rapid and accurate survey be performed of the extent of arterial disease. Color-assisted duplex sonography was applied prospectively in 17 consecutive patients with the clinical diagnosis of peripheral arterial disease who had not previously undergone angiography. Results of angiography of the femoropopliteal arteries were graded and localized in one of seven approximately equal arterial segments. These were compared with similar segmental maps made with sonography. For the detection of stenosis or occlusion in any of the 238 segments, the sensitivity was 0.88 (49/56), specificity 0.95 (173/182), and accuracy 0.93 (222/238). The average time taken to survey both limbs was 29 min. We conclude that color-assisted duplex sonography is an accurate and rapid tool for the noninvasive mapping of the extent of femoropopliteal arterial disease.

Contrast venography: reassessment of its role.

To compare contrast venography with noninvasive methods, 353 patients clinically suspected of having deep venous thrombosis were examined with venography and independently with combined Doppler flow sounds and plethysmography. Noninvasive examinations had a sensitivity of 96% and a specificity of 90%. Positive noninvasive tests had a 94% predictive value, and negative noninvasive tests had a 93% predictive value. The overall accuracy of the noninvasive tests was 94% (331 of 353) compared with venography. Since venography itself may be subject to misinterpretation, noninvasive examinations should be the preferred initial method for diagnosing deep venous thrombosis. Venography should be reserved for situations that require additional diagnostic confirmation.

Spondyloarthropathy from long-term hemodialysis.

Twenty-six patients undergoing long-term hemodialysis who had hand and wrist abnormalities were examined for the presence of concurrent spinal disease. Six patients (23%) were found to have spinal disease on radiographs. In four, the findings resembled those of a destructive spondyloarthropathy, and in two, a less destructive erosive arthritis. A review of the spinal radiographs of 31 patients with normal hands and wrists revealed no such abnormalities. Postmortem examinations of two patients with spondyloarthropathy demonstrated extensive deposition of beta-2 microglobulin, an amyloid-like substance. The authors conclude that the disease is similar in both areas and represents a skeletal response to chronic renal failure and long-term hemodialysis. The disease may occur more frequently with an increased duration of hemodialysis, in one area of the skeleton if another area is already affected, and is probably not infectious if multiple areas are involved.

Osteoarthropathy of the hand and wrist in patients undergoing long-term hemodialysis.

Radiographs of the hand and wrist in 81 patients who had undergone hemodialysis for a minimum of 5 years (mean, 7.8 years) were reviewed. In 32 patients arthritic changes were found, consisting of articular erosions, joint space narrowings, periarticular cysts, and osteopenia. Seven of the 32 patients had periarticular calcific deposits. The frequency and severity of the radiographic findings increased with increasing duration of dialysis. It appears that in addition to the well-recognized secondary hyperparathyroidism there is another commonly occurring osteoarthropathy (40% in this series) related to long-term hemodialysis.