A prospective comparative study of pre-operative Duplex Ultrasound Arterial Mapping (DUAM), Digital-Subtraction Angiography (DSA) and Magnetic Resonance Angiography (MRA) in Critical Lower Limb Ischaemia (CLI) prior to Endovascular Revascularization (EvR).Clinical, Technical and Economic outcome.

OBJECTIVES:
Our strive is to equate clinical pragmatism, homodynamic outcomes of DUAM, DSA and MRA in patient management with CLI prior to EvR.

METHODS:
From 2002 through 2006, 631 patients were referred with peripheral vascular disease. 285 patients had CLI of which 194 underwent EvR. Pre-operative evaluation involved DUAM (n=85), MRA (n=55) and DSA (n=54). Patients were assessed at 1 day, 6 weeks, 3 months and 6 months post-operatively. Composite end-points were primary patency, target vessel revascularization, limb salvage, major adverse events and cost-effectiveness.

RESULTS:
There were 49 aorto-iliac (25%) and 145 infra-inguinal (75%) EvR’s. Demographics and risk score were not statistically different. Mean ankle brachial index and primary patency rates were significantly better in the DUAM group compared to MRA (p=0.018 and p=0.02 respectively) and analogous to DSA (p=0.69). Length of hospital stay was significantly less in the DUAM cohort compared to DSA and MRA (p<0.0001 and p=0.0003 respectively). Predicted target lesion revascularization was accurate observed in the DUAM group compared to MRA.
CONCLUSIONS:
Clinical correlation suggests that DUAM is superior to MRA with more precise target lesion localization. DUAM is an economically proficient, prudent primary modality for management patients with CLI and significantly shortened length of hospital stay. DUAM offers an outstanding minimally invasive, accurate and scrupulous consecutive data with patency rates and limb salvage comparable to EvR based on DSA and superior to MRA.