Non-invasive aortoiliac assessment

Abstract

Objectives: To assess the accuracy of Duplex ultrasound in the assessment of aortoiliac disease.

Design: Prospective, semi-blind study.

Setting: Vascular laboratory and radiology departments, University Hospital.

Materials and methods: Ninety-two patients underwent assessment of the aortoiliac segment by femoral pulse palpation, Duplex ultrasound and biplanar arteriography. Of these 184 aortoiliac segments, 68 were also assessed by intraarterial pressure measurements and 80 by magnetic resonance angiography (MRA).

Main results: Femoral pulses were abnormal in all 32 occluded aortoiliac segments. Of 152 patent segments, femoral pulse palpation was misleading in 50 (33%). MRA detected all occlusions and had a sensitivity of 71% and specificity of 68% for stenoses, compared to arteriography. Colour flow Duplex misdiagnosed four occlusions as stenoses. Duplex had a sensitivity of 91% and specificity of 93% for stenoses when compared to arteriography. Two stenoses, detected by Duplex and confirmed by pressure gradients, were missed by arteriography.

Conclusions: Pressure measurements remain the gold standard for aortoiliac examination, arteriography providing only morphological information. The limitations of femoral pulse palpation should be appreciated. Although MRA was faster, Duplex examination proved slightly more sensitive to stenoses. At present, colour Duplex provides the best non-invasive assessment of aortoiliac disease and could prevent unnecessary arteriograms.