# Comparison between vascular Doppler ultrasound and contrast exams in chronic peripheral arterial disease

## TL;DR

This study shows that vascular Doppler ultrasound is reliable for deciding between two types of surgery for arterial disease, especially when contrast agents are unavailable.

## Contribution

The study validates vascular Doppler ultrasound as a reliable alternative to contrast exams for treatment decisions in peripheral arterial disease.

## Key findings

- Doppler ultrasound had 100% sensitivity compared to CT angiography for identifying femoral artery issues.
- There was 100% agreement in treatment choice between Doppler ultrasound and contrast exams in the first phase.
- In the second phase, Doppler ultrasound showed 94% agreement with contrast exams for treatment decisions.

## Abstract

Vascular Doppler ultrasound (DUS) has evolved over recent years because of improvements in the technology involved in the acquisition and processing of sound and image data. The method is an excellent option for use in diagnosis of peripheral arterial disease considering its availability, low cost, and absence of harmful effects. The breakdown of logistics supply chains caused by the COVID-19 pandemic caused worldwide shortages of iodinated contrast, highlighting the need to validate alternative diagnostic methods.

To use DUS for decision-making when choosing between by-pass and endovascular surgery for femoropopliteal arterial disease and compare the results to those of iodinated contrast exams.

We compared DUS with examinations using contrast for identification of stenoses/occlusions and indication of surgical treatment (by-pass vs. endovascular). In the first phase of the study the results were merely compared, DUS vs. angiotomography. Then, in the second phase, the vascular ultrasound results were used for screening between by-pass and endovascular treatment, comparing DUS with angiotomography in cases scheduled for by-pass and with arteriography in endovascular patients.

In phase 1, the sensitivity of DUS compared to CT angiography was 100% for the SFA territory. When considering solely the choice of bypass vs. endovascular treatment, the results showed 100% agreement for phase 1 and 94% for phase 2.

Notwithstanding the sample size, the study fulfilled its objective of demonstrating the reliability of DUS for indicating the treatment choice between by-pass and endovascular surgery.

A ecografia vascular com Doppler (EVD) evoluiu nos últimos anos devido ao aprimoramento da tecnologia de aquisição e processamento da imagem. A disponibilidade do exame, o baixo custo e a ausência de efeitos deletérios de radiação e contraste tornam este método uma excelente opção no diagnóstico da doença arterial periférica. As quebras nas cadeias de suprimentos devido à pandemia de covid-19 levaram a uma escassez global de contraste iodado, reforçando a importância de validar abordagens alternativas.

Utilizar a EVD na decisão entre cirurgia aberta ou endovascular para doença arterial femoropoplítea e comparar os resultados com exames de contraste iodado.

Comparamos EVD com exames contrastados (angiotomografia e arteriografia) em relação à localização de estenoses/oclusões e indicação do tratamento cirúrgico (by-pass vs. endovascular). Em uma primeira fase, os resultados foram apenas comparados entre EVD e angiotomografia. Numa segunda fase, os resultados da EVD foram usados na triagem entre by-pass vs. endovascular), sendo comparados com angiotomografia nos casos de cirurgia aberta e comparados com a arteriografia nos casos de tratamento endovascular.

A sensibilidade da EVD em comparação com a angiotomografia na fase 1 foi de 100% para o território da artéria femoral superficial. Ao considerar apenas a indicação de by-pass
versus endovascular, os resultados mostraram 100% de concordância para a Fase 1 e 94% para a Fase 2.

Com a ressalva do tamanho amostral, o estudo cumpriu seu objetivo de demonstrar a confiabilidade da EVD na indicação do tratamento cirúrgico entre aberto ou endovascular.