The Assessment Value Of Duplex Ultrasound Artery Mapping (DUAM) Prior The Lower Extremity Revascularization

ObjectiveLower limb arteriosclerosis obliterans is the most important Lower limb peripheral arterial disease(PAD)in old men,Typical symptoms include intermittent claudication(pain on walking),ischaemic rest pain,ulceration and gangrene.The Lower Extremity Revascularization surgery is the most effective treatment for this disease.Duplex Ultrasound Artery Mapping(DUAM)has been investigated as a potential replacement for invasive contrast arteriography(CA)prior to lower extremity revascularization in recent years.The sensitivity and specificity of Duplex scanning in detecting significant stenosis at angiography(≥50%)were calculated.Agreement between angiography and DUAM was also assessed by Cohen's kappa statistics(k).Materials and MethodsStudy populationWe enrolled 26 patients(6 females and 20 males)who were consecutively admitted to our hospital(from January 2006 to October 2007)for lower limb artery Arteriosclerosis Obliterans.Of 26 patients,21 had severe intermittent claudication (81%),7 had critical limb ischemia(27%)and 3 had skin lesions(12%).Duplex ultrasound Artery Mapping(DUAM)All patients underwent arterial color duplex ultrasound scanning of the lower limbs performed by the researcher.Color duplex ultrasound scanning was performed using a Philips Image Point echography machine(Phillips Medical Systems,The Netherlands).Duplex ultrasound Artery Mapping was drew by the end of the check.ArteriographyWithin 15 days of Duplex ultrasound scanning,all patients underwent a conventional contrast angiography scanning via the femoral or axillary route. Angiograms were performed and reported by a team of two radiologists who were unaware of the Duplex scanning findings.ResultsGood diagnostic agreement between DUAM and DSA was achieved in the whole arterial axis and every district:for the whole arterial axis(k=0.78)with a sensitivity of 86.4%and a specificity of 92.4%,for the common iliac district(k=1.00)with a sensitivity of 100.0%and a specificity of100.0%,for the external iliac district(k=0.85)with a sensitivity of 84.6%and a specificity of 97.4%,for the Common femoral district(k=0.74)with a sensitivity of 90.0%and a specificity of 90.5%,for the uperficial femoral(proximal and medium district)(k=0.79)with a sensitivity of 96.1% and a specificity of 90.9%,and for the uperficial femoral(distal district)(k=0.62)with a sensitivity of 89.5%and a specificity of 84.9%,and for the popliteal district(k=0.77) with a sensitivity of 88.9%and a specificity of 88.2%,and for the anterior tibial district(k=0.76)with a poor sensitivity of 52.4%and a high specificity of 93.5%,and the posterior tibial district(k=0.76)with a poor sensitivity of 55.0%and a high specificity of 90.6%.ConclusionDuplex ultrasound artery mapping(DUAM)can be drew conveniently,and it have high accuracy compared with arteriography.Duplex ultrasound artery mapping (DUAM)would be a good image evaluation method prior the lower extremity revascularization.