Cirugía sin arteriografía del sector femoropoplíteo y distal

Abstract

Summary Aims To describe the current state of clinical research being carried out using arterial Dopplerultrasoundtechniques inpatients with chronic ischemia ofthe lower limbs. We will, however, be focusing mainly on the possibilities of performing infrainguinal revascularisation surgery with colour Doppler ultrasound scanning as a substitutefor arteriography. Development We analyse the advantages and disadvantages of arteriography and of colour Doppler ultrasound in the preoperative diagnosis of these patients. We then describe the clinical experience, comparing it with preoperative arteriography in the femoropopliteal and distal sector, as well as two important aspects in Doppler ultrasound studies: the possible decrease in its diagnostic reliability in the exploration of the distal sector in the presence of proximal stenoses and the capacity of Doppler ultrasound scanning to establish a correct surgical strategy depending on the gold standard we use to establish the comparison. Conclusions 1) With theproper level of experience, it is possible to perform lower limb revascularisations with the sole help of preoperative Doppler ultrasound with a similar degree of safety to that obtained after carrying outpreoperative arteriography; 2) Arteriography should be selectively integrated, eitherpreoperatively or intraoperatively, in order to avoid a large number of angiographic explorations; 3) It is still not altogether clear which groups of patients need additional preoperative angiography, which would benefit from intraoperative angiography and which can be operated on without angiographic exploration.