Purpose: To assess the efficacy of color Doppler imaging
for decision making in the treatment of patients with lower extremity
peripheral arterial disease (PAD) compared to digital subtraction angiography
(DSA). Materials and Methods: Color Doppler scan
was done on patients suspected for lower limb PAD, a day prior to the DSA which
was done by a vascular surgeon. Also, for the patients who were candidates for
endovascular intervention based on the color Doppler arterial mapping results,
endovascular interventions were performed at the same time if the DSA findings are correlated
with the color Doppler map. The grading for evaluated segments was normal,
insignificant stenosis (<50%), hemodynamically significant stenosis (≥50%)
and occlusion. We yielded the diagnostic efficacy indices of Doppler for
detecting arterial stenosis in each 18 different arterial segments below the
renal arteries including, infrarenal aorta, common and external iliac, common
femoral, superficial femoral (proximal, middle and distal segments), deep
femoral, popliteal artery, tibioperoneal trunk, anterior and posterior tibial
arteries (proximal, middle and distal segments) and peroneal artery (proximal
and distal segments). Then, we yielded the kappa agreement between Doppler and
DSA findings considering the grade of stenosis in 18 arterial segments
separately. Results: Totally
115 lower extremities (2045 arterial segments) were evaluated in 90 patients
[mean age: 60.8 ± 8.9 (range: 47 - 84 years old)] of which 68 (75.6%) were men. The
sensitivity of color Doppler for all arterial segments was 90% or higher except
for common iliac artery, distal segment of superficial femoral artery and
proximal segments of anterior and posterior tibialis and peroneal arteries.
However, the specificity was 89% or higher, in all arterial segments. Kappa
agreement was 0.72 or higher in all segments (All P-Values < 0.001). Conclusion: This
study suggests that considering excellent capability of color Doppler
sonography in the evaluation of lower extremity arterial disease, color Doppler
arterial mapping is sufficient for decision making in the treatment of these
patients and can reduce the rate of diagnostic angiography.