Invited commentary

Abstract

The authors have presented us with a convincing study demonstrating in 585 patients screened for peripheral arterial disease that duplex ultrasound imaging of the superficial femoral artery (SFA) measuring intimal thickness and stenosis is a more sensitive test than the ankle-brachial index (ABI) for the presence of early atherosclerosis. This conclusion should come as no surprise. The ABI detects only significant stenosis at rest and can be confounded by circumferential calcification. Duplex ultrasound is a more sophisticated device providing more information than ABI. The more important question the authors do not address is whether the lower extremity should be screened at all. Intimal thickening of the carotid artery has long been known to be a sensitive predictor of generalized atherosclerosis and the accompanying risks of myocardial and cerebrovascular events. This study does not investigate the question of whether intimal thickening or stenosis of the SFA is a more sensitive measure for early atherosclerosis than intimal thickening of the carotid artery. Many patients desire lower extremity screening as a means of evaluating leg pain. An ABI would likely be as useful as a duplex ultrasound scan in demonstrating flow-limiting stenosis. The authors also do not comment on this issue. As screening vascular examinations become more frequently funded by private individuals or governmental agencies, it will be important to determine the answer to these questions to utilize the resources committed to screening examinations most efficiently. Duplex ultrasound of the superficial femoral artery is a better screening tool than ankle-brachial index to identify at risk patients with lower extremity atherosclerosisJournal of Vascular SurgeryVol. 47Issue 4PreviewThe purpose of vascular disease screening is early identification of atherosclerotic disease and the aim of an ankle-brachial index (ABI) is to identify lower extremity (LE) atherosclerosis as a marker for coronary artery disease (CAD). However, early evidence of atherosclerosis may be present in the superficial femoral artery (SFA) with a normal resting ABI. This study was performed to determine if SFA duplex ultrasound (DUS) could detect more patients with LE atherosclerosis than an ABI; be performed in the same or less time as the ABI measurement; and be associated with similar vascular disease markers as the ABI. Full-Text PDF Open Archive