Alt ekstremite periferik arter hastalığı tanısında Doppler ultrasonografi ve multidedektör bilgisayarlı tomografi anjiyografi bulgularının karşılaştırılması

Amaç. Sistemik aterosklerozun bir belirtisi olan periferik arter hastalığı (PAH) aort kavsinindistalinde kalan arterlerde anlamlı daralmaya neden olur. Lezyonun yerinin belirlenmesi içinsıklıkla kullanılan ve invazif olmayan inceleme yöntemleri Doppler ultrasonografi (US), manyetikrezonans anjiyografi (MRA) ve bilgisayarlı tomografi anjiyografidir (BTA). Girişim öncesindedamar patolojisinin kesin olarak lokalize edilebilmesi için kullanılan yöntem konvansiyonelanjiyografidir. Multidedektör teknolojisinin gelişmesi ile BTA çoğu olguda konvansiyonelanjiyografinin yerini almaya başlamıştır. Çalışmamızın amacı alt ekstremite PAH olan olgulardaDoppler USnin tanı değerini BTA bulguları ile birlikte değerlendirmektir. Yöntem. Bu çalışmayaPAH bulguları olan 45 hasta dahil edildi. Hastaların 35inde (%77,8) intermittan kladikasyon, 7hastada (%15,5) istirahat ağrısı, 3 hastada (%6,7) iskemik ülserasyon mevcut idi. Her bir bacak 7arterial segmente ayrılıp 45 hastadaki 90 bacak olarak 630 arter segmenti BTA ve Doppler US iledeğerlendirildi. Her bir hastaya aynı gün içerisinde önce Doppler US sonra BTA uygulandı.Doppler US ve BT sonuçları değerlendirildi. BTA ile saptanan darlık derecesine göre Doppler USbulgularındaki değişimler değerlendirildi. Bulgular. Kırk beş hasta (32 erkek 13 kadın; ortalamayaş 53,8±4,8) ile çalışma tamamlandı. Femoropopliteal arterin patolojik segmente sahip olmayüzdesi diğer damarlarinkine göre anlamlı olarak daha yüksek bulundu (p0,05).Olguların çoğunluğu (%85) normal damar çapına sahipti ve bu olguların %98,1inde pik sistolikhız oranı(PSHO) 1 olarak bulundu ve %6,4ünde ise puls yokluğu saptandı. Olguların %7,3indedamar tam oklüde olmasına rağmen bu olguların %0,8inde PSVR 1 idi ve %85,1inde pulsyokluğu vardı. Sonuç. Genel olarak BTA bulguları ile oldukça paralel sonuçlar veren Doppler USPAH olgularının değerlendirmesinde başarılı bir yöntemdir.

Comparison of the Doppler ultrasonography and the multidetector computed tomography f indings in the lower extremity peripheric artery disease

Aim. Peripheral arterial disease (PAD) is indication of systemic atherosclerosis that give rise tosignificant stenosis of the out of the distal aortic arch arteries. Doppler Ultrasonography (US),magnetic resonance angiography (MRA) and computed tomography angiography (CTA) arenoninvasive methods and frequently used for determining to the lesion location. Contrastarteriography is a method to localized exact vessel pathology before intervention.With the enhanceof multidetector technology, CTA sit in conventional angiography.The aim of study is that lowerextremity PAD with cases, the evaluation of the diagnostic value of Doppler US with the findingsof CTA. Method. 45 patients were included with the PAD findings in this study. There were 35(77.8%) intermitten claudication, 7 (15.5%) rest pain and 3 (6.7%) ischemic ulseration of thepatients. Each leg divided into 7 arterial segments, 630 arterial segments as 90 leg of the 45patients were evaluated with CTA and Doppler US. Each of the patients were performed beforeDoppler US after CTA within the same day then were evaluated Doppler US and CT angiographyresults. Doppler US findings were evaluated in according to the degree of stenosis determined byCTA. Results. This study completed forty-five patients (32 males 13 females; mean age53.8±4.8). We found significantly higher that have percentage of the pathologic segments of thefemoropopliteal artery as to the other vessels (p0.05). Themajority of cases (85%) had normal vessel diamater and peak systolic velocity ratio (PSVR) wasfound 1 in 98.1% of cases and non pulsed was found in 6.4 %. Although being vessel completeocluded in 7.3% of cases, PSVR was found 1 in 0.85% of this cases and there were no pulsed in85,1%.Conclusion. Generally gives to notably parallel results with CTA findings which DopplerUS is a successful modality for the evaluation of PAD cases.

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1. Welten GM, Schouten O, Chonchol M, Hoeks SE, Bax JJ, Van Domburg RT, et al. Welten GM, Schouten O, Chonchol M, Hoeks SE, Bax JJ, Van Domburg RT, Poldermans D. Prognosis of patients with peripheral arterial disease. J Cardiovasc Surg (Torino) 2009; 50: 109-21.
2. Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: The Framingham Study. J Am Geriatr Soc 1985; 33: 13-8.
3. Slot HB, Strijbosch L, Greep JM. Interobserver variability in single-plane aortography. Surgery 1981; 90: 497-503.
4. Thiele BL, Strandness DE Jr. Accuracy of angiographic quantification of peripheral atherosclerosis. Prog Cardiovasc Dis 1983; 26: 223-36.
5. Hatsukami TS, Primozich J, Zierler RE, Strandness DE Jr. Color Doppler characteristics in normal lower extremity arteries. Ultrasound Med Biol. 1992; 18: 167-71.
6. Waugh JR, Sacharias N. Arteriographic complications in the DSA era. Radiology 1992; 182: 243-6.
7. Hankey GJ, Warlow CP, Sellar RJ. Cerebral angiographic risk in mild cerebrovascular disease. Stroke 1990; 21: 209-22.
8. Catalano C, Fraioli F, Laghi A, Napoli A, Bezzi M, Pediconi F, Danti M, Nofroni I, Passariello R. Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography. Radiology 2004; 231: 555- 63.
9. Prokop M. Multislice CT angiography. Eur J Radiol 2000; 36: 86-96.
10. Rubin GD, Shiau MC, Schmidt AJ, Fleischmann D, Logan L, Leung AN, Jeffrey RB, Napel S. Computed tomographic angiography: historical perspective and new state-of-the-art using multi detector-row helical computed tomography. J Comput Assist Tomogr 1999; 23: S83-90.
11. Jager KA, Phillips DJ, Martin RL, Hanson C, Roederer GO, Langlois YE, Ricketts HJ, Strandness DE Jr. Noninvasive mapping of lower limb arterial lesions. Ultrasound Med Biol 1985; 11: 515-21.
12. Moneta GL, Yeager RA, Antonovic R, Hall LD, Caster JD, Cummings CA, Porter JM. Accuracy of lower extremity arterial duplex mapping. J Vasc Surg 1992; 15: 275-83.
13. Allard L, Cloutier G, Durand LG, Roederer GO, Langlois YE. Limitations of ultrasonic duplex scanning for diagnosing lower limb arterial stenoses in the presence of adjacent segment disease. J Vasc Surg 1994; 19: 650-7.
14. Polak JF, Karmel MI, Mannick JA, O'Leary DH, Donaldson MC, Whittemore AD. Determination of the extent of lower-extremity peripheral arterial disease with color-assisted duplex sonography: comparison with angiography. AJR Am J Roentgenol 1990; 155: 1085-9.
15. Moneta GL, Yeager RA, Antonovic R, Hall LD, Caster JD, Cummings CA, Porter JM. Accuracy of lower extremity arterial duplex mapping. J Vasc Surg 1992; 15: 275-84.
16. Lai DT, Huber D, Glasson R, Grayndler V, Evans J, Hogg J, Etheridge S. Colour duplex ultrasonography versus angiography in the diagnosis of lower-extremity arterial disease. Cardiovasc Surg 1996; 4: 384-8.
17. Krnic A, Vucic N, Sucic Z. Duplex scanning compared with intra-arterial angiography in diagnosing peripheral arterial disease: three analytical approaches. Vasa 2006; 35: 86-91.
18. Aly S, Sommerville K, Adiseshiah M, Raphael M, Coleridge Smith PD, Bishop CC. Comparison of duplex imaging and arteriography in the evaluation of lower limb arteries. Br J Surg 1998; 85: 1099-102.
19. Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: the Framingham Study. J Am Geriatr Soc 1985; 33: 13-8.
20. Cronenwett JL, Warner KG, Zelenock GB, Whitehouse WM Jr, Graham LM, Lindenauer M, Stanley JC. Intermittent claudication. Current results of nonoperative management. Arch Surg 1984; 119: 430-6.
21. Elsman BH, Legemate DA, van der Heijden FH, de Vos HJ, Mali WP, Eikelboom BC. Impact of ultrasonographic duplex scanning on therapeutic decision making in lower-limb arterial disease. Br J Surg 1995; 82: 630-3.
22. Rieker O, Düber C, Schmiedt W, von Zitzewitz H, Schweden F, Thelen M. Prospective comparison of CT angiography of the legs with intraarterial digital subtraction angiography. AJR Am J Roentgenol 1996; 166: 269-76.
23. Carpenter JP, Owen RS, Baum RA, Cope C, Barker CF, Berkowitz HD, Golden MA, Perloff LJ. Magnetic resonance angiography of peripheral runoff vessels. J Vasc Surg 1992; 16: 807-13.