الفهرس | Only 14 pages are availabe for public view |
Abstract The nonnal anatomy of lower extremity artery tree was described, followed by pathogenesis, risk factors and complication of atherosclerosis, clinical presentation and examination of a patient with lower extremity atherosclerotic disease, basic physical principles of Doppler-Duplexand color-duplex ultrasonography, artifacts of CDS, CDS examination technique and interpretation of its results. Each limb was divided into 9 ilio-femoro-popliteal (CIA, EIA, CFA, Prof. FA, prox. SFA, mid. SFA, dist.SFA, Prox. pop. A and dist pop. A and 6 infrapopliteal segments, prox. and dist. halves of PTA, ATA and peroneal artery. CDS classified atherosclerotic lesions in ilio femoro-popliteal segments into normal, hemodynamically nonsignificant (less than 50% DR), hemodynamically significant lesions (50-99% DR) and total occlusion (100%DR) while in infrapopliteal segment, CDS classified segment into either patent or occluded. We suggested that any patient with lower extremity atherosclerotic disease should be assessed first by thorough clinical history and examination, ABI and CDS which maybe enough in some patients especially when CDS . examination is negative due to its overall high NPV 96% while in remaining patients, CDS can identify specific segments for arteriographic study allowing excellent arteriogram with attention to t11e diseased segments with less examination time, less contrast media and consequently less complication. Also preliminary CDS in cases of focal lesion can save the patient a second arteriographic. study by preparing the radiologist before examination for the possibility of percutaneous transluminal angioplasty (PTA) so that both procedures are performed in the same session. Furthermore, CDS guide the radiologist to the side, site and number of lesions amenable to PTA and direction of catheter placement to avoid unfortunate situation of finding another lesion amenable to PTA but having to reschedule the patient for a second arteriographic study due to disadvantageous access site. Also preoperative CDS can identify concomitent iliac artery focal significant lesion with diffuse femoropopliteal disease thus allowing staged fashion management with PTA performed for the iliac lesion several days before distal arterial reconstruction to improve inflow and consequently a successful bypass operation. CDS is invaluable prior to infrainguinal arterial reconstruction not only in the assessment of inflow and runoff but in saphenous vein mapping as well as CDS is invaluable for following the results of intervention and it is the first practical accurate method for graft surveillance in terms of time, cost, effort and reliability, increasing the cumulative assisted primary patency rate to 96% at 1 year and 85% at 5 5’ears. Color duplex ultrasonagraphy has the capability of providing anatomic and hemodynamic information from the pelvic and lower extremity arteries down to the dorsalis pedis artery. The categorization of lower extremity atherosclerotic disease by CDS has been shown to have the anatomic accuracy, of arteriography in addition to providing direct hemodynamic information previously unobtainable by noninvasive methods. selective integration of CDS as an adjunct to the clinical history, physical examination and pressure measurements can provide precise information demonstrating the morphology (stenosis versus occlusion) and location of arterial lesions to specific arterial segment. These information can then be used to plan subsequent arteriography or interventional procedures. The infonnation generated is reliable, cost effective and accurate enough in many cases to allow intervention without confirmatory arteriography as CDS provides enough precise information to obviate the need for arteriography ·in certain instances and permit more selective use in others. Although, CDS will not completely replace arteriography, it has assumed an important initial role in pre-angioplasty and pre-operative evaluation. We recommend that CDS should become the standard modality for screening patient with lower extremity atherosclerotic disease this eliminating unnecessary invasive studies but we think that complete replacement of arteriography by CDS scanning, in lower extremity arterial disease, is premature but both modalities are complementary to each other in many patients and CDS replace arteriography in some situations . |