Aly, Sayed A. A. F.; (1998) Duplex ultrasound in the assessment of peripheral arterial disease. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Arteriography plays a central role in the assessment of peripheral arterial disease. Arteriography is associated with the risk of damage to the artery, peripheral embolisation, hazards of intra-arterial injection and exposure to ionising radiation. Arteriography provides an anatomical assessment of arterial stenosis but does not measure the functional results of the stenosis. Modern high resolution ultrasound imaging technology enables non-invasive assessment of vascular diseases and allows functional assessment of blood flow. This investigation is of proven value in studying carotid disease. The aim of the study was to determine the accuracy of duplex ultrasonography (DUS) in assessment of lower limb arterial disease in comparison with arteriography (IA DSA). A technical comparison has been made between the description of arterial lesion as indicated by DUS and IA DSA. In addition, the sensitivity of DUS in assessing multisegmental arterial disease has been determined. The clinical decision has been investigated in a further study in which five surgeons were asked to determine patient management based on IA DSA and DUS data in the same patient group. Concordance between management strategies was assessed. DUS was used as the primary method of investigation in further series of patients. Criteria were established to determine which patients would require angiography. The computer-assisted image analysis was used to study the ultrasound images of arterial stenosis and a method of analysing such images objectively was established. Two studies have been included in this section. These assess the technical accuracy of ultrasound image analysis compared with histological examination of plaque. The reproducibility of the image analysis has also been tested. I have developed a classification for peripheral arterial disease to be used to facilitate the communication between vascular laboratory staff who perform the duplex ultrasonography and surgeons who use this information. Finally I demonstrated the effect of the plaque morphology on the outcome following balloon angioplasty in iliac and femoro-popliteal lesions. The results of this study may be used to assess which patients may be best treated by balloon angioplasty and which would be best managed by bypass surgery. This series of investigations has shown that DUS provides an assessment of arterial disease in the limb which probably exceeds the sensitivity and accuracy of conventional angiography. Information about the nature of the stenotic plaque can be obtained and the outcome of the balloon angioplasty predicted. Vascular surgeons will rely more on this investigation in the future.

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