Papel de la cartografía arterial con eco-Doppler en la toma de decisiones terapéuticas en la isquemia crítica de los miembros inferiores

Abstract

Summary Introduction. Arteriography has been considered as the gold-standard in decision making for critical ischaemia of the lower limbs. However, angiography may produce complications, is invasive and only evaluates morphological information. Meanwhile, duplex is able not only to evaluate the morphology of the stenosis but to assess its haemodynamic effects. Duplex reliability has been proven in many diagnostic areas when compared to angiography. Aim. To determinate the value of ultrasound arterial mapping as single test in decision making for treating patient with critical ischaemia of lower limbs. Patients and methods. Prospective and comparative study in patients with critical ischaemia of lower limbs. In all, we performed ultrasound arterial mapping to 112 patients recruited in our department during the year 2002. We only performed arteriography in those patients with high risk of major amputation or in those in whom ultrasound was not conclusive. Patients were allocated in two groups of decision making: (A) those in whom the therapy was based on mapping alone, and (B) when arteriography was considered the test to make the therapeutical decision. Both groups were comparable as we found no statistical differences (p > 0.05). We recorded and compared the accumulative patency at 1 and 6 months (log-rank). Only in the group in which both test were performed (B) we could compare the degree of coincidence in decision making between mapping and arteriography; and degree of coincidence of the two tests with the intraoperative findings. Results. The degree of coincidence mapping-arteriography was 92,8% (p 0.05). Conclusion. Ultrasound arterial mapping may be enough in the majority of patients for decision making in patients with critical lower limbs ischaemia; may reduce up to 50% the number of angiograms in this particular group of patients. [ANGIOLOGIA 2004; 56: 433-43]