Noninvasive Detection of Iliac Artery Disease and Prediction of Its Severity from Doppler Spectral Analysis in Common Femoral Artery

Abstract

The direct interrogation of iliac artery disease (IAD) with color-coded duplex scanning is limited by the presence of intestinal gas or obesity. The purposes of this study were to examine the diagnostic accuracy of duplex ultrasound (DUS) analysis of spectral waves in common femoral artery (CFA) for detection of IAD and to predict its severity.

DUS and arteriography were performed in 107 lower extremities in this study. The following were calculated from the CFA spectral waves obtained by DUS: peak systolic velocity (PSV), acceleration (PSV/pulse rise time), and deceleration (PSV/pulse decay time). In patients with isolated IAD, the treadmill exercise test was also performed to evaluate the ischemic severity expressed as recovery rate of ankle pressure index five minutes after exercise (RR-API). Forty-six lower extremities with IAD and 61 without IAD were diagnosed by arteriography. PSV was significantly reduced in lower extremities with IAD (109.5 ±32.7 vs 59.8 ±32.9 cm/s, P<0.05). The deceleration detected IAD with a greater specificity and sensitivity vs acceleration (100.0 vs 82.0% and 97.8 vs 82.6%, respectively). Moreover, the acceleration and deceleration significantly corre lated with the RR-API (r=0.589, P<0.05 and r=0.779, P < 0.01, n=14, respectively).

The present evaluation is a simple and accurate technique to augment other exami nations for detection of IAD and to assess its ischemic severity.

Get full access to this article

View all access options for this article.

References

Sacks D. , Robinson ML , Marinelli DL , et al: Peripheral arterial Doppler ultrasonography: Diagnostic criteria . J Ultrasound Med 11:95-103, 1992.

Langsfeld M. , Nepute J. , Hershey FB , et al: The use of deep duplex scanning to predict hemodynamically significant aortoiliac stenoses. J Vasc Surg 7:395-399, 1988.

Fronek A. , Coel M. , Bernstein EF : Quantitative ultrasonographic studies of lower extremity flow velocities in health and disease. Circulation 53:957-960, 1976.

Fronek A. , Johansen KH , Dilley RB , et al: Noninvasive physiologic tests in the diagnosis and characterization of peripheral arterial occlusive disease. Am J Surg 126:205-214, 1973.

Burnham SJ , Jaques P. , Burnham CB : Noninvasive detection of iliac artery stenosis in the presence of superficial femoral artery obstruction. J Vasc Surg 16: 445-452, 1992.

Fitzgerald DE , Gosling RG , Woodcock JP : Grading dynamic capability of arterial collateral circulation. Lancet 1:66-67, 1971.

Gosling RG , Dunbar G. , King DH , et al: The quantitative analysis of occlusive peripheral arterial disease by a nonintrusive ultrasonic technique. Angiology 22: 52-55, 1971.

Gosling RG , King DH : Continuous wave ultrasound as an alternative and complement to X-rays in vascular examination. In: Cardiovascular Applications of Ultrasound . Amsterdam: North-Holland , 1974, Chap 22: pp 266-285.

Johnston KW , Maruzzo BC , Cobbold Rsc : Doppler methods for quantitative measurement and localization of peripheral arterial occlusive disease by analysis of the blood flow velocity waveform . Ultrasound in Med Biol 6:209-223, 1978.

10.

Hamilton Wap , Fulton TJ , Gay P. , et al: Locating aortofemoral disease by measuring flow velocity in the femoral artery with Doppler ultrasound . Vasc Diagn Ther 2:37-45, 1982.

11.

Skidmore R. , Woodcock JP : Physiological interpretation of Doppler-shift waveforms—I. Theoretical considerations. Ultrasound in Med Biol 6:7-10, 1980.

12.

Skidmore R. , Woodcock JP : Physiological interpretation of doppler-shift waveforms—II. Validation of the Laplace transform method for characterization of the common femoral blood-velocity/time waveform. Ultrasound in Med Biol 6:219-225, 1980.

13.

Johnston KW , Kassam M. , Koers J. , et al: Comparative study of four methods for quantifying Doppler ultrasound waveforms from the femoral artery. Ultrasound in Med Biol 10:1-12, 1984.

14.

Zeuchner J. , Geitung JT , Lukes P. , et al: Angiography and color flow duplex ultrasonography in the evaluation of peripheral ischemic occlusive arterial disease. Acta Radiol 35:270-274, 1994.

15.

Vashisht R. , Ellis MR , Skidmore C. , et al: Color-coded duplex ultrasonography in the selection of patients for endovascular surgery . Br J Surg 79:1030-1031, 1992 .

16.

Moneta GL , Yeager RA , Antonovic R. , et al: Accuracy of lower extremity arterial duplex mapping. J Vasc Surg 15:275-284, 1992.

17.

Baxter GM , Polak JF : Lower limb color flow imaging: A comparison with ankle:brachial measurements and angiography. Clin Radiol 47:91-95, 1993.

18.

Cossman DV , Ellison JE , Wagner WH , et al: Comparison of contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities. J Vasc Surg 10:522-529, 1989.

19.

Moneta GL , Yeager RA , Lee RW , et al: Noninvasive localization of arterial occlusive disease: A comparison of segmental Doppler pressures and arterial duplex mapping. J Vasc Surg 17:578-582, 1993.

20.

Gardner AW , Skinner JS , Cantwell BW , et al: Relationship between foot transcutaneous oxygen tension and ankle systolic blood pressure at rest and following exercise. Angiology 42:481-490, 1991.