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Treatment planning for peripheral arterial disease based on duplex ultrasonography and computed tomography angiography: consistency, confidence and the value of additional imaging.
- Source :
-
Surgery [Surgery] 2014 Aug; Vol. 156 (2), pp. 492-502. Date of Electronic Publication: 2014 Jun 19. - Publication Year :
- 2014
-
Abstract
- Background: Duplex ultrasonography (DUS) can be used for treatment planning for lower extremity peripheral arterial disease (PAD), but has not replaced contrast-enhanced imaging such as computed tomography angiography (CTA). We assessed DUS-based treatment planning for consistency, confidence, and the value of additional CTA among multinational surgeons.<br />Methods: Data from 12 patients with PAD were reviewed by 2 American vascular surgeons individually and 1 Dutch vascular department by consensus. Reviewers selected treatment based on DUS first and based on added CTA second. Agreement and consistency of treatment plans was assessed using kappa statistics (κ). Imaging quality and therapeutic confidence were scored (1-5) and assessed with t-tests.<br />Results: Of the 36 treatment plans formulated, additional CTA confirmed 27 (75%), changed 6 (17%), and supplemented 3 (8%) plans. The approach never changed when open revascularization was selected based on DUS (14 plans; 39%). Agreement between DUS- and CTA-based treatment planning was substantial, with a mean kappa (μκ) of 0.68, but agreement between reviewers was fair (μκ DUS, 0.24; μκ CTA, 0.23). CTA received greater average scores than DUS for quality (4.36 vs 3.29; P < .0001) and confidence (4.36 vs 3.26; P < .0001). Reviewers often expressed the need for additional imaging after DUS (mean, 63%).<br />Conclusion: PAD treatment planning based on CTA was mostly consistent with DUS-based treatment plans, although CTA was still felt to be needed to increase confidence. This observation suggests that to promote greater use of less invasive DUS imaging, not only improvement of DUS quality but also improvement of clinician confidence is required.<br /> (Copyright © 2014 Mosby, Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Angiography
Cohort Studies
Extremities blood supply
Female
Humans
Intermittent Claudication diagnostic imaging
Intermittent Claudication therapy
Ischemia diagnostic imaging
Ischemia therapy
Male
Middle Aged
Netherlands
Patient Care Planning statistics & numerical data
Peripheral Arterial Disease therapy
Pilot Projects
Tomography, X-Ray Computed
Ultrasonography, Doppler, Duplex
United States
Peripheral Arterial Disease diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1532-7361
- Volume :
- 156
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 24953278
- Full Text :
- https://doi.org/10.1016/j.surg.2014.03.035