Preoperative mapping of the aortoiliac territory with duplex ultrasound in patients with peripheral arterial occlusive disease

Abstract Objective Duplex ultrasound (DUS) arterial mapping of the aortoiliac area is limited by obesity, abdominal gas, and the need to use a low-frequency probe (and therefore poorer resolution) in the examination. The aim of this study was to analyze the degree of agreement between DUS mapping of the aortoiliac area and angiography or contrast-enhanced computed tomography angiography (CTA). Methods This was a retrospective observational study. Between November 2006 and June 2015, there were 173 patients with a surgical indication for aortoiliac occlusive disease included, with preoperative aortoiliac DUS mapping and subsequent CTA or intraoperative angiography. Sensitivity, specificity, positive predictive value, and negative predictive value of DUS as an arterial mapping test were analyzed, as was the degree of agreement with angiography/CTA and agreement between the surgical indication based on DUS and the final surgical technique performed. Results Of 173 DUS mapping tests, 155 were evaluated (89.6%); the remaining 18 were not able to be evaluated because of the patient's obesity or bowel gas. Overall accuracy of DUS for predicting significant artery lesions was as follows: 92% sensitivity (95% confidence interval [CI], 88%-95%), 96% specificity (95% CI, 95%-97%), 89% positive predictive value (95% CI, 86%-93%), and 97% negative predictive value (95% CI, 96%-98%). Agreement with angiography/CTA had a κ index of 0.81 (95% CI, 0.77-0.84), which reflects a good degree of agreement. Surgical indications based on DUS mapping were correct in 89% of cases (138/155). Conclusions DUS mapping of the aortoiliac territory could be used as a single preoperative imaging test in aortoiliac occlusive disease in patients whose DUS examination is able to be evaluated.