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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. [Copyright &y& Elsevier]

Abstract: Objectives: To demonstrate the minimum training requirement when performing ultrasound of peripheral arterial disease. Design: Prospective and blinded comparative study. Material: 100 limbs in 100 consecutive patients suffering from peripheral arterial disease, 74% suffering critical limb ischemia, were enrolled during a 9 months period. Methods: One physician with limited ultrasound experience performed all the ultrasound examinations of the arteries of the most symptomatic limb. Before enrolling any patients 15 duplex ultrasound examinations were performed supervised by an experienced vascular technologist. All patients had a digital subtraction arteriography performed by an experienced vascular radiologist, unaware of the ultrasound result. Results: The number of insufficiently insonated segments (non-diagnostic segments) was significantly reduced during the study; from 9% among the initial 50 limbs to 2% among the last 50 limbs (P <0.0001). This improvement was evident only in the infragenicular segments, as the performance within the supragenicular segments was good from the beginning. There was no change in the agreement between ultrasound and arteriography from the initial 50 patients (overall Kappa=0.66, (95%-CI: 0.60–0.72); supragenicular Kappa=0.73 (95%-CI: 0.64–0.82); infragenicular Kappa=0.61 (95%-CI: 0.54–0.69)) to the last 50 patients (overall Kappa=0.66 (95%-CI: 0.60–0.72), supragenicular Kappa=0.67 (95%-CI: 0.57–0.76); infragenicular Kappa=0.66 (95%-CI: 0.58–0.73)). Conclusion: The minimum training requirement in ultrasound imaging of peripheral arterial disease appears to be less than 50 ultrasound examinations (probably only 15 examinations) for the supragenicular segments and 100 examinations for the infragenicular segments. [Copyright &y& Elsevier]