Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202301041
Jornal Vascular Brasileiro
Original Article

Comparação entre ecografia vascular com Doppler e exames contrastados na doença arterial crônica periférica

Comparison between vascular Doppler ultrasound and contrast exams in chronic peripheral arterial disease

Alex Aparecido Cantador; Ana Terezinha Guillaumon

Downloads: 0
Views: 67

Resumo

Contexto: A ecografia vascular com Doppler (EVD) evoluiu nos últimos anos devido ao aprimoramento da tecnologia de aquisição e processamento da imagem. A disponibilidade do exame, o baixo custo e a ausência de efeitos deletérios de radiação e contraste tornam este método uma excelente opção no diagnóstico da doença arterial periférica. As quebras nas cadeias de suprimentos devido à pandemia de covid-19 levaram a uma escassez global de contraste iodado, reforçando a importância de validar abordagens alternativas.

Objetivos: Utilizar a EVD na decisão entre cirurgia aberta ou endovascular para doença arterial femoropoplítea e comparar os resultados com exames de contraste iodado.

Métodos: Comparamos EVD com exames contrastados (angiotomografia e arteriografia) em relação à localização de estenoses/oclusões e indicação do tratamento cirúrgico (by-pass vs. endovascular). Em uma primeira fase, os resultados foram apenas comparados entre EVD e angiotomografia. Numa segunda fase, os resultados da EVD foram usados na triagem entre by-pass vs. endovascular), sendo comparados com angiotomografia nos casos de cirurgia aberta e comparados com a arteriografia nos casos de tratamento endovascular.

Resultados: A sensibilidade da EVD em comparação com a angiotomografia na fase 1 foi de 100% para o território da artéria femoral superficial. Ao considerar apenas a indicação de by-pass versus endovascular, os resultados mostraram 100% de concordância para a Fase 1 e 94% para a Fase 2.

Conclusões: Com a ressalva do tamanho amostral, o estudo cumpriu seu objetivo de demonstrar a confiabilidade da EVD na indicação do tratamento cirúrgico entre aberto ou endovascular.

Palavras-chave

ecografia vascular com Doppler, doença arterial periférica, angiotomografia, endovascular, contraste iodado

Abstract

Background: Vascular Doppler ultrasound (DUS) has evolved over recent years because of improvements in the technology involved in the acquisition and processing of sound and image data. The method is an excellent option for use in diagnosis of peripheral arterial disease considering its availability, low cost, and absence of harmful effects. The breakdown of logistics supply chains caused by the COVID-19 pandemic caused worldwide shortages of iodinated contrast, highlighting the need to validate alternative diagnostic methods. 

Objectives: To use DUS for decisionmaking when choosing between by-pass and endovascular surgery for femoropopliteal arterial disease and compare the results to those of iodinated contrast exams

Methods: We compared DUS with examinations using contrast for identification of stenoses/occlusions and indication of surgical treatment (by-pass vs. endovascular). In the first phase of the study the results were merely compared, DUS vs. angiotomography. Then, in the second phase, the vascular ultrasound results were used for screening between by pass and endovascular treatment, comparing DUS with angiotomography in cases scheduled for by-pass and with arteriography in endovascular patients. 

Results: In phase 1, the sensitivity of DUS compared to CT angiography was 100% for the SFA territory. When considering solely the choice of bypass vs. endovascular treatment, the results showed 100% agreement for phase 1 and 94% for phase 2.

Conclusions: Notwithstanding the sample size, the study fulfilled its objective of demonstrating the reliability of DUS for indicating the treatment choice between by-pass and endovascular surgery

Keywords

Doppler ultrasound; peripheral arterial disease; angiotomography; endovascular; iodinated contrast

References

1 Geiger MA, Guillaumon AT. Primary stenting for femoropopliteal peripheral arterial disease: analysis up to 24 months. J Vasc Bras. 2019;18:e20160104. http://doi.org/10.1590/1677-5449.010416. PMid:31191625.

2 Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517-38. http://doi.org/10.1016/S0741-5214(97)70045-4. PMid:9308598.

3 Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5-67. http://doi.org/10.1016/j.jvs.2006.12.037. PMid:17223489.

4 Lowery AJ, Hynes N, Manning BJ, Mahendran M, Tawfik S, Sultan S. A prospective feasibility study of duplex ultrasound arterial mapping, digital-subtraction angiography, and magnetic resonance angiography in the management of critical lower limb ischemia by endovascular revascularization. Ann Vasc Surg. 2007;21(4):443-51. http://doi.org/10.1016/j.avsg.2006.08.005. PMid:17628263.

5 London NJ, Nydahl S, Hartshorne T, Fishwick G. Use of colour duplex imaging to diagnose and guide angioplasty of lower limb arterial lesions. Br J Surg. 1999;86(7):911-5. http://doi.org/10.1046/j.1365-2168.1999.01180.x. PMid:10417564.

6 Wain RA, Berdejo GL, Delvalle WN, et al. Can duplex scan arterial mapping replace contrast arteriography as the test of choice before infrainguinal revascularization? J Vasc Surg. 1999;29(1):100-7, discussion 107-9. http://doi.org/10.1016/S0741-5214(99)70352-6. PMid:9882794.

7 Koelemay MJ, Legemate DA, de Vos H, van Gurp JA, Reekers JA, Jacobs MJ. Can cruropedal colour duplex scanning and pulse generated run-off replace angiography in candidates for distal bypass surgery? Eur J Vasc Endovasc Surg. 1998;16(1):13-8. http://doi.org/10.1016/S1078-5884(98)80086-5. PMid:9715711.

8 Hingorani AP, Ascher E, Marks N. Duplex arteriography for lower extremity revascularization. Perspect Vasc Surg Endovasc Ther. 2007;19(1):6-20. http://doi.org/10.1177/1531003506298080. PMid:17437972.

9 Eiberg JP, Rasmussen JBG, Hansen MA, Schroeder TV. Duplex ultrasound scanning of peripheral arterial disease of the lower limb. Eur J Vasc Endovasc Surg. 2010;40(4):507-12. http://doi.org/10.1016/j.ejvs.2010.06.002. PMid:20609601.

10 Cantador AA, Siqueira DED, Jacobsen OB, et al. Estudo comparativo entre ultrassonografia duplex e angiotomografia no acompanhamento pós-operatório da correção endovascular de aneurismas do eixo aortoilíaco. Radiol Bras. 2016;49(4):229-33. http://doi.org/10.1590/0100-3984.2014.0139. PMid:27777476.

11 Vlachopoulos C, Georgakopoulos C, Koutagiar I, Tousoulis D. Diagnostic modalities in peripheral artery disease. Curr Opin Pharmacol. 2018;39:68-76. http://doi.org/10.1016/j.coph.2018.02.010. PMid:29549715.

12 Franz RW, Jump MA, Spalding MC, Jenkins JJ 2nd. Accuracy of duplex ultrasonography in estimation of severity of peripheral vascular disease. Int J Angiol. 2013;22(3):155-8. http://doi.org/10.1055/s-0033-1336830. PMid:24436603.

13 Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019 June;69(6S):3S-125S.e40. http://doi.org/10.1016/j.jvs.2019.02.016. PMid:31159978.

14 García-Rivera E, Cenizo-Revuelta N, Ibáñez-Maraña MA, et al. Doppler ultrasound as a unique diagnosis test in peripheral arterial disease. Ann Vasc Surg. 2021;73:205-10. http://doi.org/10.1016/j.avsg.2020.10.027. PMid:33249132.

15 Martinelli O, Alunno A, Drudi FM, Malaj A, Irace L. Duplex ultrasound versus CT angiography for the treatment planning of lower-limb arterial disease. J Ultrasound. 2021;24(4):471-9. http://doi.org/10.1007/s40477-020-00534-y. PMid:33165702.
 


Submitted date:
08/06/2023

Accepted date:
01/21/2024

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
668bf8cea95395673960f203 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections