THE IMPORTANCE OF DUPLEX SCANNING IN CHOOSING SURGICAL TACTICS FOR THE TREATMENT OF ATHEROSCLEROSIS OBLITERANS OF LOWER LIMB ARTERIES

S.A. Dadvani, Ye.G. Artyukhina, D.A. Ulyanov
Department of Vascular Surgery, Faculty Surgical Clinic,
I.M. Sechenov Moscow Medical Academy,
Moscow, Russia

The choice of the optimal methods for surgical treatment of patients with occlusive arterial diseases depends on the site, character and hemodynamiс significance of lesions. This task could be achieved by means of ultrasound examination of lower limb arteries, which was the main purpose of our research. Duplex scanning (DS) was accomplished in 198 consecutive patients with atherosclerosis obliterans of lower limb arteries. The mean age of the patients was 57.26 years. Color Doppler imaging and power flow Doppler were employed in examination of 73 patients. The basic principle determining the hemodynamic significance of atherosclerotic lesions was the relationship between stenosis of the vascular lumen, blood flow changes and an increase of the peak systolic velocity. The DS data were compared to the results of X-ray angiography, intraoperative revisions and histologic examinations of the evacuated plaques in 174 patients who had undergone reconstructive operations in the aortofemoral and/or femoropopliteal segments, DS allows visualization of the portions of stenosis, vascular aneurysms, atherosclerotic plaques which are not detectable by X-ray angiography. The multisegmental and bilateral character of lesion and its localization primarily at the sites of arterial subdivision was a typical sign of atherosclerosis. In addition, we could determine the character of atherosclerotic plaques (fibrous, calcified, complicated by hemorrhage or ulcerations), their site, length and thus the indications for a reconstructive procedure, DS helped define the indications for reconstructive operations (femoropopliteal, aortofemoral bypass grafting, endarterectomy, profundaplasty), lumbar sympathectomy or amputation. As compared to the intraoperative revision data, the diagnostic accuracy of DS was 94.1-97.5%. The results of our research evidence that DS may limit the indications for X-ray angiography and be of significant assistance in choosing the surgical tactics in patients with atherosclerosis obliterans of lower limb arteries.

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