Diagnosis of arterial occlusive disease of the upper extremities: comparison of color duplex sonography and angiography

Abstract

Purpose: The aim of this study was to assess the abilities of color duplex sonography (CDUS) to detect and characterize arterial occlusive disease of the upper extremities.

Methods: We prospectively compared the results of CDUS with those of intra-arterial digital subtraction angiography, which were considered definitive, in patients with symptomatic arterial occlusive disease of the upper extremities. In each extremity, we visualized 9 arterial segments, which were each evaluated for stenoses and occlusions. Each segment was categorized on each imaging modality as not significantly narrowed (narrowed by <50%), significantly narrowed (narrowed by > or =50% but <100%), or occluded (100%).

Results: We examined a total of 578 segments in 57 patients (34 men and 23 women) with a mean age of 50 years (range, 20-74 years). CDUS had a sensitivity, a specificity, a positive predictive value, a negative predictive value, and an accuracy of 98%, 99%, 97%, 99.5%, and 99%, respectively, for detecting occluded lesions and 79%, 100%, 100%, 99%, and 99%, respectively, for detecting hemodynamically significantly stenotic lesions. Notably, the sensitivity of CDUS for diagnosing significantly stenotic lesions (79%) was lower than that for diagnosing occlusive disease (98%).

Conclusions: With high sensitivity and accuracy rates, CDUS is a reliable screening method for detecting arterial occlusive disease of the upper extremities. This modality efficiently provides anatomic and hemodynamic data that are useful in cases of such disease.