¿Es útil el eco-Doppler portátil en el diagnóstico de enfermedad arterial periférica? Estudio de validación / Usefulness of a portable duplex scanning device in the diagnosis of peripheral arterial disease. A validation study

RESUMEN

Objetivos: Validar el eco-Doppler portátil (EDP) para el diagnóstico de enfermedad arterial periférica (EAP) y analizar la influencia del tipo de lesión arterial en el resultado. Material y método: Estudio prospectivo 60 extremidades (45 pacientes), edad media 68 años, 33 hombres/12 mujeres, 30% diabéticos, 37% dislipémicos, 58% hipertensos, 27% cardiópatas. Realizamos un EDP siguiendo las guías de diagnóstico vascular no invasivo del sector femoropoplíteo (8 segmentos), comparándolo con la arteriografía. Clasificamos como estenosis < 50%, > 50% y trombosis. Calculamos sensibilidad (S), especificidad (E), VPP, VPN e índice de acuerdo kappa. Las lesiones arteriales se clasifican en únicas o múltiples y se comparan con el grado de acierto del EDP (test chi cuadrado). Resultados: En el sector supragenicular el índice de acuerdo es bueno para diagnóstico de trombosis (K=0,779, S=86%, E=95%, VPP=79%, VPN=96%) y de estenosis > 50% (K=0,651, S=82%, E=85%, VPP=70% y VPN=92%).En el sector infragenicular el grado de acuerdo es bueno para diagnóstico de trombosis (K=0,610, S=72%, E=87%, VPP=77%, VPN 84%), pero moderado en estenosis > 50% (K=0,472, S=68%, E=78%, VPP=70% y VPN=76%).El EDP identifica correctamente 94% de trombosis en lesiones únicas frente 85% en estenosis múltiples (p=0,008) y 86% de estenosis > 50% en lesiones únicas frente 79% en múltiples (p=0,070). Conclusiones: La sensibilidad, especificidad, VPP y VPN del EDP son buenos en diagnóstico de EAP siendo más sensible para diagnóstico de trombosis que estenosis.- El EDP ofrece mayor fiabilidad en diagnóstico de EAP en sector supragenicular frente al infragenicular.- Las lesiones arteriales múltiples disminuyen la fiabilidad del EDP en el diagnóstico de trombosis(AU)

ABSTRACT

Objectives: The aim of this study is investigate the agreement between a portable duplex scanner (PDS and angiography in the diagnosis of peripheral arterial disease (PAD) and analyse the influence of the type of lesion on the result. Material and methods: A prospective study was conducted on 60 limbs (45 patients) with a mean age of 68 years, 33 males/12 females, 30% diabetes mellitus, 37% dyslipidaemias, 58% arterial hypertension, and 27% heart diseases. A PDS was made following the guidelines for the non-invasive diagnosis of femoral-popliteal sector (8 segments) and comparing it with the angiography. The stenosis were classified as <50%, and thrombosis as >50%. The sensitivity (Se), specificity (Sp), Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Kappa (K) index of agreement was calculated. The arterial lesions were classified in singles or multiples, and were compared with the level of accuracy of the PDS (chi-squared test). Results: In the above-knee segment, the level of agreement was good for the diagnosis of thrombosis (K=0.779, Sp=86%, Se=95%, PPV=79%, NPV=96%) and stenosis >50% (K=0.651, Se=82%, Se=85%, PPV=70% and NPV=92%).In the below-knee segment, the index of agreement was good for the diagnosis of thrombosis (K=0.610, Sp=72%, Se=87%, PPV=77%, PNV=84%), and moderate in stenosis >50% (K=0.472, Sp=68%, Se=78%, PPV=70% and NPV=76%).The PDS correctly identified 94% of thrombosis in single lesions compared to 85% in the multiple lesions (P=.008) and 86% in stenosis >50% in single lesions compared to 79% in multiple lesions (P=.070)(AU)