The value of the peak systolic velocity ratio in the assessment of the haemodynamic significance of subcritical iliac artery stenoses.

OBJECTIVES: iliac stenoses with a PSV ratio between 2.0 and 3.0 in patients with symptomatic arterial obstructive disease of the legs might be misinterpreted when compared with intra-arterial pressure measurements (IAPM). The aim of this study was to compare the value of the PSV ratio with IAPM as the reference standard in the assessment of the haemodynamic significance of subcritical iliac artery stenoses (iliac stenosis with PSV ratio between 1.5 and 3.5). DESIGN, PATIENTS AND METHODS: fifty-eight iliac tracts in 53 consecutive patients with symptomatic arterial obstructive disease of the legs with an isolated stenosis with PSV ratio between 1.5 and 3.5 were studied prospectively. The results of those iliac duplex scanning were compared to IAPM. Results a poor agreement was found between IAPM and PSV ratios. For the PSV ratios > or =2.0, 2.5 and 3.0 the sensitivities were 74%, 37% and 16%, respectively. The specificities were 70%, 90% and 95%, the positive predictive values 82%, 88% and 86%, respectively, and the negative predictive values 58%, 43% and 37%, respectively. CONCLUSION: the results of this study show that the PSV ratio parameter is not accurate enough to evaluate the haemodynamic significance of subcritical iliac artery stenoses.

Duplex scanning allows selective use of arteriography in the management of patients with severe lower leg arterial disease.

PURPOSE: Until April 1997 we routinely performed intra-arterial digital subtraction angiography (iaDSA) in all patients with severe lower leg ischemia requiring intervention. After a comparative study of duplex scanning (DS), pulsegenerated runoff, and iaDSA of the lower leg arteries, we postulated that management could be based on DS/pulse-generated runoff in 59% of patients. We prospectively evaluated the safety of such a noninvasive workup strategy. METHODS: All consecutive patients referred with severe lower leg ischemia between April 1997 and September 1998 were eligible. Management was based on DS with iaDSA being performed only on indication. Complications within 30 days and 12- and 24-month patency, survival, and limb salvage rates were recorded and compared with historical controls. RESULTS: A total of 125 limbs in 114 patients were evaluated (74% rest pain or tissue loss). In 97 (78%) of 125 limbs, management was based on DS. It comprised conservative treatment (n = 33, 0% after iaDSA), percutaneous transluminal angioplasty (n = 25, 16% iaDSA), femoropopliteal bypass graft (n = 29, 17% iaDSA), femorotibial bypass graft (n = 29, 62% iaDSA), and other surgical procedures (n = 8, 4% iaDSA). Overall, the mortality within 30 days was 4% (5/114), and 2-year survival was 83%. Two-year primary and secondary patency and limb salvage rates were 75%, 93%, and 93% after a femoropopliteal bypass operation, respectively. One-year primary and secondary patency and limb salvage rates were 35%, 73%, and 74%, respectively, after a femorocrural bypass operation. There were no differences in patient characteristics, indication for specific treatment, and immediate and intermediate term outcome between the study and reference population. CONCLUSION: In a vascular unit with wide expertise in DS of the lower leg arteries, management of patients with severe lower leg ischemia can be based on DS in most patients without negative effects on clinical outcome within 30 days and at 2-years' follow-up.