COMPARATIVE EVALUATION OF COLOR DOPPLER AND CONVENTIONAL DIGITAL SUBTRACTION ANGIOGRAPHY IN INFRA GENICULAR ARTERIAL DISEASE

Abstract

BACKGROUND: A frequent clinical situation involves a patient who has infra-genicular peripheral arterial occlusive disease. Apart from vasculitis, thromboembolism, and trauma, Burgers Disease and Atherosclerotic Disease are the most prevalent causes of arterial insufficiency in our system, particularly in middle-aged smokers of low socioeconomic level. The supraventricular artery system can be evaluated well with color doppler (CD), however the infra-genicular arteries are frequently difficult to observe due to their deeper location. Due to the hardening and constriction of arteries caused by peripheral artery occlusive disease (PAOD), there is a higher risk of lower extremity amputation. Therefore, it is necessary to compare the precision of non-invasive diagnostic techniques like Color Doppler (CD) to that of traditional digital subtraction angiography (CDSA).

AIM: This study compares infra-genicular arterial disease patients' color doppler and traditional digital subtraction angiography results.

MATERIAL AND METHOD: This prospective study involved 40 patients with lower limb ischemia and was conducted in the Department of Radiodiagnosis. The patients' complete demographic information, cardiovascular risk factors, comorbidities, and peripheral artery disease clinical stage were collected. Three segments from each patient's anterior tibial, posterior tibial, and peroneal arteries were investigated by color doppler and DSA in 150 segments total. A total of 150 vascular segments were used in the blind analysis, which used two-way contingency tables and kappa values. The study received ethics committee approval, and the patient's consent was obtained for catheter angiography.

RESULTS: 150 vascular segments in total underwent blind analysis of the data. Two-way contingency tables and kappa statistics were used to examine the results. In our investigation, we found that color doppler had Sensitivity = 83%, Specificity = 92%, PPV = 66%, and NPV = 96% in the infra-genicular arterial system disorder. Smoking, hyperlipidemia, hypertension, and diabetes were the main risk variables identified in the study's history, which was collected for the purpose of evaluating risk factors. When patients were categorized based on the percentage of stenosis, 10% of them had lesions that were 1 to 19% stenotic, 20% had lesions that were 20 to 49% stenotic, 32% had lesions that were 50 to 99% stenotic, and 38% had total occlusion.

CONCLUSION: Due to its low cost, non-invasive nature, lack of radiation risk, lack of contrast-related responses, and lack of nephrotoxicity, ultrasound should be used as the initial assessment modality for patients with arterial insufficiency. In this investigation, we discovered that the inferior genicular arteries had a high NPV (96%) of color Doppler testing, indicating that the presence of normal color flow and normal spectral waveform in these arteries may remove the necessity for arteriography. On the other hand, CT Angiography is a helpful method for determining segmental length and collateral circulation in addition to offering a replica of the arterial system's road map.

KEYWORDS: Color Doppler, DSA, Digital subtraction angiography, peripheral arterial occlusive disease Multiplanar reconstruction, Peak systolic velocity, Vascular stenosis.