Background:

Angiography is the gold standard for diagnosis and to evaluate the extension of peripheral arterial disease (PAD). However, it is invasive and confers risk of nephrotoxicity. The use of vascular ultrasonography (VU) could be a non-invasive diagnostic alternative. The aim of this study is to compare the VU with angiography for the diagnosis and therapeutic plan in EAP.

Material and methods:

Observational study of concordance in patients with PAD who underwent USG duplex and arteriography in the Hospital Regional Licenciado Adolfo López Mateos. The following variables were compared; segment affected by PAD, vascular access route and blood vessels to treat. The kappa concordance index was used, and the Chi-square test was used as an inferential test. A p < 0.05 was considered statistically significant.

Results:

36 patients were included, of average age 68 ± 10 years, 61% were male. 97.2% had diabetes mellitus, 75% had high blood pressure, 16.7% had dyslipidemia, 36.1% were smokers and 30.6% had chronic kidney disease. The predominant clinical manifestation among the patients was critical ischemia with tissue loss in 80.6% of cases, pain at rest in 11.1% of cases and claudication when walking < 200 m in 8.3%. The most affected angiosoma was the tibialis anterior (55.6% of the cases), followed by the posterior tibialis (22.2%) and the type of revascularization performed on the patients was direct (61.1% of the cases). Diagnostic concordance was determined with a global kappa of = 0.713; p < 0.001; for multilevel disease, in tibial vessels the kappa was 0.769. The concordance for the TASC II system between duplex USG and arteriography had a kappa value of 0.621 (p < 0.001). The agreement between duplex USG and ASD to plan the vascular access site was 1. To identify the artery specifically affected with PAD, the agreement was 0.3.

Conclusions:

The VU was as efficient as the Arteriography for the planning of the surgical approach and the choice of the access site in PAD, as well as to identify the main circulation or affected segment, but it is an inaccurate option to identify the totality of affected arteries.

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