Further Evaluation of Duplex Ultrasound for the Evaluation of Lower Extremity Arterial Disease

In this issue of the journal, Koshy et a^l1 describe an assessment of different segments of the arterial tree by duplex. Importantly, a correlation with angiography was obtained in all cases. The authors studied only a small number of patients, but exhaustively examined all segments of the arterial tree to provide clinical data. They confirm the important finding that duplex analysis can identify significant lesions with very reasonable sensitivity. The method of analysis is meticulous and allows direct comparison to angiography performed within 24 hours of the duplex. While the authors describe well the ability to detect lesions in a range of stenoses, their data suggest the need for larger studies to allow more precise categorization of stenoses. In addition, the data suggest the need for technical advancements to allow superior scanning of difficult arterial segments. The use of duplex as a diagnostic modality for planning percutaneous intervention will continue to increase, and this will allow for the collection of larger amounts of data. The goal moving forward should be to develop criteria that can be universally applied to the arterial system and allow the most precise planning prior to angiography.

Author Affiliations: From New York Presbyterian Hospital and Columbia University Medical Center, New York, NY.

Correspondence: Nicholas J. Morrissey, MD, Assistant Professor of Surgery, Columbia/Weill Cornell Division of Vascular Surgery, the New York Presbyterian Hospital, Irving Pavilion 639, 161 Fort Washington Ave, New York, NY 10032. E-mail: njm2106@columbia.edu.