ABSTRACT
OBJECTIVE: The medical world has seen a surge in patients grappling with infragenicular peripheral arterial occlusive disease. This condition is most commonly caused by two factors – Buergers Disease and Atherosclerotic disease – afflicting middle-aged smokers belonging to low socio-economic backgrounds. In some cases, this might also be caused by factors such as trauma, thromboembolism, or vasculitis. While Color Doppler (CD) is a reliable method to assess the supragenicular arterial system, the deeper positioning of infragenicular arteries often proves challenging for proper examination using this modality. The study’s objective is to assess the efficacy of both techniques and determine which method provides more accurate and reliable results in diagnosing infragenicular arterial disease. This research is expected to contribute to the advancement of medical imaging and improve the diagnosis and treatment of infragenicular arterial disease.
METHODS: The Radiodiagnosis department of Mayo Hospital in Lahore, Pakistan, was the site of this research, which was planned as a prospective experiment. Lower limb ischemia in 50 individuals was recorded. By using CD and DSA, the participants and their afflicted lower limbs were assessed for the location and grading of artery lesions into normal, severe stenosis, and occlusion. 150 vascular segments in total underwent blind analysis of the data. Data were examined using kappa statistics and two-way contingency tables.
RESULTS: In our investigation, we found that color doppler exhibited a sensitivity of 83%, specificity of 92%, PPV of 66%, and NPV of 96% in the disease of the infragenicular artery system.
CONCLUSIONS: A normal spectral waveform and color flow in a Color Doppler examination of the inferior genicular arteries can rule out the need for arteriography. However, the reduced positive predictive value (PPV) of Color Doppler (66%) highlights the limitations of this diagnostic tool. In such cases, DSA proves to be a more reliable and beneficial diagnostic method for patients who exhibit abnormal or absent color flow and/or spectral wave shape. In these instances, DSA provides a clearer and more detailed assessment of the arterial structure, improving the accuracy of the diagnosis. Thus, the use of DSA in conjunction with Color Doppler examination can lead to a more comprehensive and accurate diagnosis of infragenicular arterial disease.
KEYWORDS: arterial, digital subtraction angiography, color doppler