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Svendsen MBS, Ghulam QM, Zielinski AH, Lachenmeier C, Eiberg JP. Validation of an assessment tool for estimation of abdominal aortic aneurysm compression in diagnostic ultrasound. ULTRASONICS 2021; 116:106484. [PMID: 34102524 DOI: 10.1016/j.ultras.2021.106484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 03/26/2021] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
The study investigated ultrasound (US) transducer push, tantamount to applied transducer pressure, during abdominal aortic aneurysm (AAA) US scanning in a simulated non-clinical setup. During an assessment of maximal AAA diameter on a three-dimensional print-based AAA phantom, US transducer push varied as much as 2000% (range: 0.52-12.45 kPa) amongst 16 experienced sonographers. The mean transducer push was 5.54 ± 3.91 kPa (CV = 0.71). Deformation of a standardized gel-pad allowed for transducer push calculation based on US images; Young's modulus of the gel-pad was estimated to 44,26 N/m2. The method is theoretically validated in a safe and non-clinical environment. Future investigations with the aim of clinical validation of the gel-pad principle on AAA patients are suggested, including the objectification of the magnitude of an eventual transducer push-related error during US AAA diameter measurement.
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Affiliation(s)
| | - Qasam Mohammed Ghulam
- Department of Vascular Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Alexander Hakon Zielinski
- Department of Vascular Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Christian Lachenmeier
- Copenhagen Academy for Medical Education and Simulation (CAMES), Teilum, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jonas Peter Eiberg
- Copenhagen Academy for Medical Education and Simulation (CAMES), Teilum, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Vascular Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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European Society for Vascular Surgery (ESVS) Certification of Theoretical and Practical Competences in Basic Vascular Ultrasound: Validity Investigation of the Assessment Tools. Eur J Vasc Endovasc Surg 2020; 60:933-941. [PMID: 32900586 DOI: 10.1016/j.ejvs.2020.07.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/09/2020] [Accepted: 07/24/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to gather validity evidence for the Assessment of basic Vascular Ultrasound Expertise (AVAUSE) tool, and to establish a pass/fail score for each component, to support decisions for certification. METHODS A cross sectional validation study performed during the European Society for Vascular Surgery's annual meeting. Validity evidence was sought for the theoretical test and two practical tests based on Messick's framework. The participants were vascular surgeons, vascular surgical trainees, sonographers, and nurses with varying experience levels. Five vascular ultrasound experts developed the theoretical and two practical test components of the AVAUSE tool for each test component. Two stations were set up for carotid examinations and two for superficial venous incompetence (SVI) examinations. Eight raters were assigned in pairs to each station. Three methods were used to set pass/fail scores: contrasting groups' method; rater consensus; and extended Angoff. RESULTS Nineteen participants were enrolled. Acceptable internal consistency reliability (Cronbach's alpha) for the AVAUSE theoretical (0.93), carotid (0.84), and SVI (0.65) practical test were shown. In the carotid examination, inter-rater reliability (IRR) for the two rater pairs was good: 0.68 and 0.78, respectively. The carotid scores correlated significantly with years of experience (Pearson's r = 0.56, p = .013) but not with number of examinations in the last five years. For SVI, IRR was excellent at 0.81 and 0.87. SVI performance scores did not correlate with years of experience and number of examinations. The pass/fail score set by the contrasting groups' method was 29 points out of 50. The rater set pass/fail scores were 3.0 points for both carotid and SVI examinations and were used to determine successful participants. Ten of 19 participants passed the tests and were certified. CONCLUSION Validity evidence was sought and established for the AVAUSE comprehensive tool, including pass/fail standards. AVAUSE can be used to assess competences in basic vascular ultrasound, allowing operators to progress towards independent practice.
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Normahani P, Poushpas S, Alaa M, Bravis V, Aslam M, Jaffer U. Study protocol for a comparative diagnostic accuracy study of bedside tests used to detect arterial disease in diabetes: TEsting for Arterial disease in Diabetes (TrEAD) study. BMJ Open 2020; 10:e033753. [PMID: 32029491 PMCID: PMC7044995 DOI: 10.1136/bmjopen-2019-033753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In the UK, over 7000 amputations are performed each year because of diabetes. Up to 80% of these are preceded by a foot ulcer and could therefore be prevented with improvements in ulcer care. Peripheral arterial disease is an important risk factor for the development of diabetic foot ulceration. However, its diagnosis in diabetes is challenging due to the presence of neuropathy and arterial calcification. Commonly used bedside tests either have low sensitivities or little supporting evidence to justify their use. Duplex ultrasound (DUS) has good correlation to angiography findings but a full scan is difficult to learn and time consuming to perform. We have previously demonstrated that a focused DUS of the distal anterior and posterior tibial arteries at the ankle (podiatry ankle duplex scan (PAD-scan)) can be readily learnt by novices and performed rapidly and accurately. The primary aim of this study is to determine the diagnostic accuracy of the PAD-scan and other commonly used bedside tests in detecting arterial disease in diabetes. METHODS AND ANALYSIS The study will include 305 patients presenting to diabetic foot clinics at two centres. Arterial assessment will be performed using the following index tests: the PAD-scan, pulse palpation, audible handheld Doppler, Ankle Brachial Pressure Index, Toe Brachial Pressure Index and transcutaneous pressure of oxygen. Patients will then undergo a full lower limb arterial DUS by a blinded vascular scientist as a reference test. ETHICS AND DISSEMINATION Approval was gained from NRES Committee London (REC reference 17/LO/1447). Findings will be disseminated by various methods including international presentations and publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04058626).
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Affiliation(s)
- Pasha Normahani
- Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Sepideh Poushpas
- Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Mays Alaa
- Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | | | - Mohammed Aslam
- Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Usman Jaffer
- Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
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Shabani Varaki E, Gargiulo GD, Penkala S, Breen PP. Peripheral vascular disease assessment in the lower limb: a review of current and emerging non-invasive diagnostic methods. Biomed Eng Online 2018; 17:61. [PMID: 29751811 PMCID: PMC5948740 DOI: 10.1186/s12938-018-0494-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/02/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Worldwide, at least 200 million people are affected by peripheral vascular diseases (PVDs), including peripheral arterial disease (PAD), chronic venous insufficiency (CVI) and deep vein thrombosis (DVT). The high prevalence and serious consequences of PVDs have led to the development of several diagnostic tools and clinical guidelines to assist timely diagnosis and patient management. Given the increasing number of diagnostic methods available, a comprehensive review of available technologies is timely in order to understand their limitations and direct future development effort. MAIN BODY This paper reviews the available diagnostic methods for PAD, CVI, and DVT with a focus on non-invasive modalities. Each method is critically evaluated in terms of sensitivity, specificity, accuracy, ease of use, procedure time duration, and training requirements where applicable. CONCLUSION This review emphasizes the limitations of existing methods, highlighting a latent need for the development of new non-invasive, efficient diagnostic methods. Some newly emerging technologies are identified, in particular wearable sensors, which demonstrate considerable potential to address the need for simple, cost-effective, accurate and timely diagnosis of PVDs.
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Affiliation(s)
- Elham Shabani Varaki
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Penrith, NSW, 2750, Australia.
| | - Gaetano D Gargiulo
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Penrith, NSW, 2750, Australia
| | - Stefania Penkala
- School of Science and Health, Western Sydney University, Penrith, NSW, 2750, Australia
| | - Paul P Breen
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Penrith, NSW, 2750, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2750, Australia
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Normahani P, Aslam M, Standfield NJ, Jaffer U. The impact of a focused vascular lower limb arterial duplex (F-VLAD) scan in management decisions for acute limb ischaemia. Perfusion 2016; 32:74-80. [PMID: 27451053 DOI: 10.1177/0267659116661049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To establish the diagnostic accuracy of a 'focused vascular lower limb arterial duplex scan (F-VLAD)' developed to facilitate rapid decision-making for acute limb ischaemia (ALI). METHODS Ten cases of ALI were identified from our patient database; clinical details, history and examination findings were extracted from the clinical notes. Original 'full' duplex ultrasound (DUS) pictorial reports were 're-formatted' to include only anatomical segments included in the 'F-VLAD' scan. The series of 10 reports were emailed to 1741 vascular surgeons. Each recipient received a random mixture of full and F-VLAD scans. Participants were asked regarding next step in management and confidence in decision-making (Likert scale; 1 strongly disagree, 5 strongly agree). The cases were again sent out to the same database and respondents were asked as to the cause of ischaemia (embolic or thrombosis). RESULTS Eighty-one participants responded to the first survey and 43 participants to the second survey. Participants felt more confident making decisions regarding management using the full duplex report compared to the F-VLAD report (4 (3-4) vs 3 (2-4), median (IQR); p<0.001). However, there was no significant difference in diagnostic accuracy (differentiating embolus from thrombosis) when comparing the F-VLAD and full DUS reports (85.4% vs 88.3%; p=0.461). F-VLAD and 'full' DUS reports had comparable sensitivity (85.1% vs 86.8%), specificity (85.6% vs 89.2%),positive predictive value (PPV) (80.4% vs 81.9%) and negative predictive value (NPV) (89.2% vs 92.2%), respectively. CONCLUSION The F-VLAD scan has comparable accuracy to a traditional full DUS in diagnosing the underlying aetiology of ALI. This may facilitate surgeon-performed point-of-care DUS.
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Affiliation(s)
- Pasha Normahani
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK
| | - Mohammed Aslam
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK
| | - Nigel J Standfield
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK
| | - Usman Jaffer
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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Jaffer U, Normahani P, Matyushev N, Aslam M, Standfield NJ. Intensive Simulation Training in Lower Limb Arterial Duplex Scanning Leads to Skills Transfer in Real-World Scenario. JOURNAL OF SURGICAL EDUCATION 2016; 73:453-460. [PMID: 26861581 DOI: 10.1016/j.jsurg.2015.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/18/2015] [Accepted: 11/15/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To train novices to perform an abbreviated duplex lower limb ultrasound scan using simulation training and assess real-world skills transference. METHODS Novices undertook 3 days of simulation training. Their progress was assessed using the Duplex Ultrasound Objective Structured Assessment of Technical Skills (DUOSATS) for simulation and Cumulative Imaging Score (CIS). A final assessment day was held to assess DUOSATS for simulation and real patient scanning, CIS, cumulative diagnostic accuracy, and sections A and B of the Society of Vascular Technology examination. MSc students in vascular ultrasound were also assessed for comparison. RESULTS A total of 17 novices and 7 MSc students with 3-month training participated. Novices improved DUOSATS for simulation scores between days 1, 3, and 4: 18 (17-19) vs 27 (25-28) vs 30 (28-32), (median [interquartile range], p < 0.001). Novices improved in CIS between days 1 and 3: 10 (10-13) vs 21 (19-21), p < 0.001, with a decline on day 4: 15.3 (11.3-18.3), p < 0.001. On the final assessment day, there were no significant differences between novices and MSc students in: DUOSATS for simulation scores (30 [28-32] vs 31 [6-31.5], p = 0.85); DUOSATS for patient assessment (31 [28.7-33.7] vs 26.7 [24.5-35.7], p = 0.41); CIS (15.3 [11.3-18.7] vs 20.7 [12.3-22.2], p = 0.2), respectively. However, novices performed better in section B of the Society of Vascular Technology examination compared with MSc students (72.9% vs 54.3%, p < 0.001). Novices also demonstrated a higher diagnostic accuracy when compared with MSc students (65.7% of arterial segments correctly assessed vs 47.6%, respectively [p = 0.044]). CONCLUSIONS Intensive simulation of 3-day training achieved real patient-based assessments that were comparable to MSc students who were 3 months into their traditional training program.
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Affiliation(s)
- Usman Jaffer
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom; London Postgraduate School of Surgery, London, United Kingdom.
| | - Pasha Normahani
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
| | - Nikolay Matyushev
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom; London Postgraduate School of Surgery, London, United Kingdom
| | - Mohammed Aslam
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
| | - Nigel J Standfield
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom; London Postgraduate School of Surgery, London, United Kingdom
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New simple image overlay system using a tablet PC for pinpoint identification of the appropriate site for anastomosis in peripheral arterial reconstruction. Surg Today 2016; 46:1387-1393. [PMID: 26988854 DOI: 10.1007/s00595-016-1326-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the accuracy and utility of a new image overlay system using a tablet PC for patients undergoing peripheral arterial reconstruction. METHODS Eleven limbs treated with distal bypass surgery were studied. Three-dimensional images obtained by processing a preoperative contrast-enhanced computed tomography scan were superimposed onto the back-camera images of a tablet PC. We used this system to pinpoint a planned distal anastomotic site preoperatively and to make a precise incision directly above it during surgery. We used a branch artery near the distal anastomotic site as a reference point and the accuracy of the system was validated by comparing its results with the intraoperative findings. The precision of the system was also compared with that of a preoperative ultrasonographic examination. RESULTS Both the image overlay system and ultrasonography (US) accurately identified the target branch artery in all except one limb. In that limb, which had a very small reference branch artery, preoperative US wrongly identified another branch, whereas the image overlay system located the target branch with an error of 10 mm. CONCLUSIONS Our image overlay system was easy to use and allowed us to precisely identify a target artery preoperatively. Therefore, this system could be helpful for pinpointing the most accurate incision site during surgery.
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Crawford JD, Robbins NG, Harry LA, Wilson DG, McLafferty RB, Mitchell EL, Landry GJ, Moneta GL. Characterization of tibial velocities by duplex ultrasound in severe peripheral arterial disease and controls. J Vasc Surg 2016; 63:646-51. [DOI: 10.1016/j.jvs.2015.08.112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/27/2015] [Indexed: 11/26/2022]
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Jaffer U, Normahani P, Singh P, Aslam M, Standfield NJ. The effect of a simulation training package on skill acquisition for duplex arterial stenosis detection. JOURNAL OF SURGICAL EDUCATION 2015; 72:310-315. [PMID: 25456408 DOI: 10.1016/j.jsurg.2014.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/12/2014] [Accepted: 09/25/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES In vascular surgery, duplex ultrasonography is a valuable diagnostic tool in patients with peripheral vascular disease, and there is increasing demand for vascular surgeons to be able to perform duplex scanning. This study evaluates the role of a novel simulation training package on vascular ultrasound (US) skill acquisition. MATERIALS AND METHODS A total of 19 novices measured predefined stenosis in a simulated pulsatile vessel using both peak systolic velocity ratio (PSVR) and diameter reduction (DR) methods before and after a short period of training using a simulated training package. The training package consisted of a simulated pulsatile vessel phantom, a set of instructional videos, duplex ultrasound objective structured assessment of technical skills (DUOSATS) tool, and a portable US scanner. Quantitative metrics (procedure time, percentage error using PSVR and DR methods, DUOSAT scores, and global rating scores) before and after training were compared. RESULTS Subjects spent a median time of 144 mins (IQR: 60-195) training using the simulation package. Subjects exhibited statistically significant improvements when comparing pretraining and posttraining DUOSAT scores (pretraining = 17 [16-19.3] vs posttraining = 30 [27.8-31.8]; p < 0.01), global rating score (pretraining = 1 [1-2] vs posttraining = 4 [3.8-4]; p < 0.01), percentage error using both the DR (pretraining = 12.6% [9-29.6] vs posttraining = 10.3% [8.9-11.1]; p = 0.03) and PSVR (pretraining = 60% [40-60] vs posttraining = 20% [6.7-20]; p < 0.01) methods. CONCLUSION In this study, subjects with no previous practical US experience developed the ability to both acquire and interpret arterial duplex images in a pulsatile simulated phantom following a short period of goal direct training using a simulation training package. A simulation training package may be a valuable tool for integration into a vascular training program. However, further work is needed to explore whether these newly attained skills are translated into clinical assessment.
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Affiliation(s)
- Usman Jaffer
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom.
| | - Pasha Normahani
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
| | - Prashant Singh
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
| | - Mohammed Aslam
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
| | - Nigel J Standfield
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
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Eco-Doppler arterial del cayado de la arteria tibial anterior. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2014.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Misra S, Lookstein R, Rundback J, Hirsch AT, Hiatt WR, Jaff MR, White CR, Conte M, Geraghty P, Patel M, Rosenfield K. Proceedings from the Society of Interventional Radiology research consensus panel on critical limb ischemia. J Vasc Interv Radiol 2013; 24:451-8. [PMID: 23522155 DOI: 10.1016/j.jvir.2012.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/19/2012] [Accepted: 10/22/2012] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sanjay Misra
- Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Sultan S, Tawfick W, Hynes N. Ten-year technical and clinical outcomes in TransAtlantic Inter-Society Consensus II infrainguinal C/D lesions using duplex ultrasound arterial mapping as the sole imaging modality for critical lower limb ischemia. J Vasc Surg 2013; 57:1038-45. [PMID: 23321343 DOI: 10.1016/j.jvs.2012.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 09/24/2012] [Accepted: 10/07/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate duplex ultrasound arterial mapping (DUAM) as the sole imaging modality when planning for bypass surgery (BS) and endovascular revascularization (EvR) in patients with critical limb ischemia for TransAtlantic Inter-Society Consensus (TASC) II C/D infrainguinal lesions. METHODS This was a retrospective review evaluating the accuracy of DUAM as the sole imaging tool in determining patient suitability for BS vs EvR. Primary outcomes were the sensitivity and specificity of DUAM compared with intraoperative digital subtraction angiography. Secondary outcomes were procedural, hemodynamic, and clinical outcomes, amputation-free survival, and freedom from major adverse clinical events. RESULTS From 2002 to 2012, a total of 4783 patients with peripheral arterial disease were referred, of whom 622 critical limb ischemia patients underwent revascularization for TASC C and D lesions (EvR: n = 423; BS: n = 199). Seventy-four percent of EvR and 82% of BS were performed for TASC D (P = .218). The DUAM showed sensitivity of 97% and specificity of 98% in identifying lesions requiring intervention. Of the 520 procedures performed with DUAM alone, there was no difference regarding the number of procedures performed for occlusive or de novo lesions (EvR: 65% and 71%; BS: 87% and 78%; P = .056). Immediate clinical improvement to the Rutherford category ≤3 was 96% for EvR and 97% for BS (P = .78). Hemodynamic success was 79% for EvR and 77% for BS (P = .72). Six-year freedom from binary restenosis was 71.6% for EvR and 67.4% for BS (P = .724). Six-year freedom from target lesion revascularization was 81.1% for EvR and 70.3% for BS (P = .3571). Six-year sustained clinical improvement was 79.5% for EvR and 66.7% for BS (P = .294). Six-year amputation-free survival was 77.2% for EvR and 74.6% for BS (P = .837). There was a significant difference in risk of major adverse clinical events between EvR and BS (51% vs 70%; P = .034). Only 16.4% of patients required magnetic resonance angiography, which tended to overestimate lesions with 84% agreement with intraoperative findings. Six-year binary restenosis was 71% for DUAM procedures compared with 55% for magnetic resonance angiography procedures (P = .001), which was solely based on the prospective modality. CONCLUSIONS The DUAM epitomizes a minimally invasive, economically proficient modality for road mapping procedural outcome in BS and EvR. It allows for high patient turnover with procedural and clinical success without compromising hemodynamic outcome. The DUAM is superior to other available modalities as the sole preoperative imaging tool in a successful limb salvage program.
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Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Ireland.
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Beggs AD, Thomas PR. Point of use ultrasound by general surgeons: Review of the literature and suggestions for future practice. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2012.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Eiberg JP, Grønvall Rasmussen JB, Hansen MA, Schroeder TV. Duplex ultrasound scanning of peripheral arterial disease of the lower limb. Eur J Vasc Endovasc Surg 2010; 40:507-12. [PMID: 20609601 DOI: 10.1016/j.ejvs.2010.06.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 06/02/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the reliability and applicability of duplex ultrasound scanning (DUS) of lower limb arteries, compared with digital subtraction angiography (DSA), in patients with peripheral arterial disease (PAD). DESIGN A prospective, blinded, comparative study. MATERIALS AND METHODS A total of 169 patients were examined by DUS and DSA. Intermittent claudication (IC) was present in 42 (25%) patients and critical limb ischaemia (CLI) in 127 (75%) patients. To allow segment-to-segment comparison, the arterial tree was divided into 15 segments. In total, 2535 segments were examined using kappa (κ) statistics to test the agreement. RESULTS The agreement between DUS and DSA was very good (κ>0.8) or good (0.8 ≥ κ>0.6) in most segments, but moderate (0.6 ≥ κ>0.4) in the tibio-peroneal trunk and the peroneal artery. Agreement between the two techniques was significantly better in the supragenicular (κ=0.75 (95% confidence interval (CI): 0.70-0.80)) than in the infragenicular segments (κ=0.63 (0.59-0.67)) (p<0.001). Similarly, the technical success rate was significantly higher in the supragenicular segments (DUS: 100%; DSA: 99%) than in the infragenicular segments (both 93%) (p<0.001). DUS was the best technique for imaging of the distal crural arteries (92% vs. 97%; p<0.001) and DSA was the best technique for imaging of the proximal crural arteries (95% vs. 91%; p<0.01). Neither the agreement nor the technical success rate was influenced by the severity of PAD, that is, IC versus CLI. CONCLUSION The agreement between DUS and DSA was generally good, irrespective of the severity of ischaemia. DUS performed better in the supragenicular arteries than in the infragenicular arteries. However, DUS compared favourably with DSA in both tibial vessels, particularly in the distal part, which makes DUS a useful non-invasive alternative to DSA.
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Affiliation(s)
- J P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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