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The impact of limited vascular ultrasound studies on clinical decision making in patients with peripheral arterial disease
Douglas Wooster, MD1, Mary Angelson, B.Sc, RVT2, Elizabeth Wooster, M.Ed., PhD(c)1, Andrew Dueck, MD1.
1University of Toronto, Toronto, ON, Canada, 2Toronto West Vascular Centre, Toronto, ON, Canada.
Objectives: Combined vascular duplex ultrasound and physiologic testing provides detailed information regarding the nature, location and severity of peripheral arterial disease. Clinical decision making (CDM) with respect to medical, catheter-directed and operative management can be dictated by these findings. Resource and facility management issues have resulted in proposed protocols for limited studies. The aim of this study is to address the impact of such studies on decision-making.
Methods: 50 limbs were selected to reflect differing severity (stenosis, occlusion), location (iliac, CFA, SFA, popliteal, tibial arteries) and clinical decisions. The findings were analyzed comparing full studies, comprised of ABIs, waveforms, velocities and plaque at rest and after exercise, to the interpretation and clinical decisions if only subsets of data were available.
Results: Interventions were recommended on 22 limbs (44%); full studies were considered adequate for CDM in 100%. ABI alone was not helpful in CDM apart from a rough estimate of the presence of disease; exercise altered the interpretation in 40%. Selected waveforms at 3 levels (femoral, popliteal, ankle) guided CDM in 76%; exercise augmented this in 32%. Plaque assessment, with velocity measurements, identified location and severity accurately and improved CDM in 24%.
Conclusions: Limited ultrasound studies for peripheral arterial disease can establish the presence of disease but is inadequate to guide clinical decision-making. Caution should be exercised in the use and interpretation of such protocols.
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