Comparative study of arterial doppler with digital subtraction angiography in lower limb peripheral arterial disease: a protocol

Introduction

Peripheral arterial disease (PAD) is a major cardiovascular condition, presenting with deficient blood supply affecting the lower extremities, frequently as a result of atherosclerotic occlusive disease.¹

Approximately 10% to 25% of people over the age of 55 have PAD in their lower limbs, and the frequency rises with age. The most prominent risk factors for peripheral arterial disease include being over the age of 50 years, experiencing diabetic complications, engaging in nicotine consumption, and having dyslipidemia.² PAD itself poses a risk factor for coronary disease regardless of severity as well as for brain-vascular incidents. Individuals with PAD have a possibility of death within 10 years as compared to those without the disease.²

Patients with PAD might show symptoms or might not. The size and location of the affected artery, the extent of collateral circulation as well as the metabolic demands placed on the ischemic tissue during exercise, all of this influence the presence of symptoms.³ The majority of symptomatic individuals present with claudication, rest pain, colour changes of the limb, local tissue loss, and gangrene. An amputation may be necessary in severe cases.³

Digital subtraction angiography represents a minimally invasive technique that serves as the standard approach for percutaneous revascularization therapy in non-responsive patients with medical therapy. But while working with people who have destructive lower limb ischemia, for appropriate therapy, re-planning, and evaluation of subsequent treatment outcomes and consequences, proper interpretation of diagnostic DSA findings is essential.⁴ Several other alternative imaging procedures including Duplex Ultrasound, CT and MR angiographies, and Intra-arterial Contrast Angiography are also available.

DUS is usually the first investigation of choice, owing to its easy availability, low cost, and the non-invasive nature of the procedure. However, it does not come without its limitations. DUS is largely operator dependent; hence the user’s level of expertise can affect its quality. Moreover, deep-seated arteries, such as the infragenicular arteries in the lower limbs may prove difficult to assess, particularly if edema is present.² In addition to giving insight into the vessel’s morphology and activity, color Doppler imaging also provides detail about the vessel’s wall.⁵

Even though digital subtraction arteriography has been around for a while, duplex ultrasonography is still a common imaging method utilized in most vascular centers.⁶ On the other hand digital subtraction arteriography can be used for therapeutic as well as diagnostic purposes. With this technique, deep-seated arteries can be better visualized and smaller vessels and collaterals with the slow flow can be detected. Nonetheless, its shortcomings lie in its high radiological risk, kidney failure, and the invasive nature of the treatment all must be considered. DSA is frequently associated with post-procedure complications such as hematoma, aneurysms, and thromboembolism.²

There are other causes of PAD; The main factor causing PAD is atherosclerosis. Stroke and myocardial infarction risk are decreased by medical treatment that targets atherosclerotic risk factors which are the main factors that lead to mortality in people with PAD.⁷

Maximum systolic velocity at the location of a blockage can be used to measure variations in a cross-sectional area of the arterial lumen.⁸

Methods

Study design: The research shall be Prospective cross-sectional which will be executed in hospital.

Study setting: Sawangi, Wardha, Maharashtra’s Acharya Vinoba Bhave Rural Hospital’s radiology department will carry out this research. Hospital offering tertiary care that is fully equipped.

Study population: Patients with complaint of peripheral vascular disease who would be due for duplex ultra-Sonography or digital subtraction angiography and patients with clinical suspicion of PAD reporting to OPD. Meeting the criteria for inclusion and exclusion in the study.

Study period: 2 years

Type of sampling: purposive sampling will be used in this study.

Formula:

Sample size: The investigations will take place among patients seeking treatment for peripheral vascular disease; a total number of 78 patients will be enrolled. The list of patients undergoing treatment or opd patients will be obtained from respective sister incharge.

Disscusion

Conclusion