Diagnosis of arterial disease of the lower extremities with duplex ultrasonography

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Abstract
The development of duplex scanning carries the prospect of an entire non-invasive work-up of patients with peripheral arterial occlusive disease. To obtain the best available estimates of its diagnostic accuracy, a meta-analysis of 71 studies evaluating duplex scanning was performed. Independent methodological judgement left 16 studies for data extraction. Pooled estimates 95 per cent confidence interval of sensitivity and specificity for detection of a stenosis greater than or equal to 50 per cent or occlusion in the aortoiliac tract were 86 (80–91) per cent and 97 (95–99) per cent respectively. The results for the femoropopliteal tract compared well with this, with a sensitivity of 80 (74–85) per cent and a specificity of 96 (94–98) per cent. The accuracy of detection of a stenosis greater than or equal to 50 per cent or an occlusion in the infragenicular arteries was lower with a sensitivity and specificity of 83 (59–96) per cent and 84 (69–93) per cent respectively. Duplex scanning is an accurate tool for assessment of atherosclerotic lesions in the aortoiliac and femoropopliteal tract and can replace routine pre-interventional angiography in a substantial number of patients.