Arterial duplex for diagnosis of peripheral arterial emboli

Abstract

Background: Whether duplex ultrasound (DUS) imaging alone can be used to successfully plan revascularization for peripheral arterial embolism (PAE) is unknown. This study evaluated the utility of DUS imaging alone for the diagnosis and treatment of PAE.

Methods: Patients with cardiogenic PAE to the lower or upper extremities during a 20-year period were retrospectively evaluated. Patients with visceral or cerebral PAE were excluded. Diagnosis by DUS imaging alone was compared with contrast angiography (CA) or computed tomography angiography (CTA). Patient demographics, use of intraoperative CA, need for reintervention, length of revascularization procedure, and rate of fasciotomy and amputation were compared. Mean peak systolic velocity (PSV; cm/s) measured at the proximal, middle, and distal segment of each artery from the common femoral to the distal tibial arteries was also compared with surgical outcomes.

Results: We identified 203 extremities in 182 patients with PAE. Preoperative imaging was obtained in 89%, including DUS imaging alone (44%), CA (37%), and CTA (7%). DUS imaging was used more frequently than CA or CTA in women, older patients, patients with congestive heart failure, upper extremity PAE, and patients on antiplatelet agents preoperatively. Use of intraoperative CA, need for reintervention, rate of fasciotomy and limb loss, and hospital length of stay were similar between the two groups. No upper extremities required amputation. Patients with lower extremity emboli who underwent fasciotomy had lower mean PSVs than those free from fasciotomy at the popliteal (4 ± 6 cm/s vs 31 ± 62 cm/s; P = .03), anterior tibial (1 ± 3 cm/s vs 10 ± 16 cm/s; P = .004), and posterior tibial (2 ± 3 cm/s vs 9 ± 15 cm/s; P = .03) arteries. The 30-day mortality for the series was 25% with a median follow-up of 7.4 months. The only predictor of 30-day mortality on multivariate analysis was tobacco use (odds ratio, 3.1; 95% confidence interval, 1.4-7.0).

Conclusions: Surgical outcomes and survival for patients evaluated by preoperative DUS imaging alone for PAE are equivalent to patients evaluated with CA or CTA. PSVs in the tibiopopliteal arteries may predict the need for fasciotomy. Preoperative DUS imaging alone is sufficient for operative planning in patients with symptoms suggestive of PAE.