Uloga Dopplera u planiranju revaskularizacijskoga zahvata u perifernoj arterijskoj bolesti [The role of Doppler in revascularisation procedure planning in peripheral arterial disease]

Pavić, Predrag (2015) Uloga Dopplera u planiranju revaskularizacijskoga zahvata u perifernoj arterijskoj bolesti [The role of Doppler in revascularisation procedure planning in peripheral arterial disease]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

For years DSA has been the golden standard in peripheral arterial disease. However, it is an invasive and costly method, associated with numerous potential complications. As a noninvasive diagnostic method Doppler offers quite a few valuable information, potentially sufficient for planning revascularisation in patients suffering from peripheral arterial disease. The first part of this study involved the analysis of findings on 224 patients (252 legs) who had undergone revascularisation. Arterial Doppler findings were compared with DSA and intrainterventional/intraoperative findings. The comparison was carried out on three anatomical arterial segments, i.e., the aortoiliac, femoropopliteal and popliteocrural segments. It was appropriately scored and subsequently processed by Kappa statistical analysis. The agreement of Doppler findings with the compared findings on specific arterial segments was analysed. The results showed a good Doppler agreement with the compared findings only on the femoropopliteal segment. On the aortoiliac segment agreement was good only distally from the lesion, and on the popliteocrural segment proximally and at the level of the lesion. Conclusively, the sufficiency of Doppler in planning revascularisation has only been demonstrated on the femoropopliteal segment. On the other two anatomical segments Doppler can be sufficient only exceptionally, which still leaves DSA as the golden standard. The second part of the study focused on the cost-effectiveness analysis based on the results obtained in the retrospective study. That is, if DSA were omitted in diagnosis before revascularisation on the femoropopliteal segment, the issue of financial savings comes up. The difference between the cost price of Doppler according to DTP and the cost price of DSA according to DTG in 118 patients with femoropopliteal revascularisation would imply savings in the amount of Hrk 717,103.70. The savings could probably be even higher because, as shown by the results of the retrospective study, in some cases Doppler could also be used as the exclusive diagnostic tool in revascularisation on the aortoiliac and politeocrural segments.

Abstract in Croatian

Zlatni dijagnostički standard kod periferne arterijske bolesti je godinama bila DSA. Međutim, radi se o invazivnoj metodi, koja je skupa i vezana za potencijalne brojne komplikacije. Uporaba doplera kao neinvazivne dijagnostičke metode pruža mnogo kvalitetnih informacija, potencijalno dostatnih za planiranje revaskularizacije kod periferne arterijske bolesti. U prvome dijelu ovoga istraživanja provedena je retrospektivna studija kojom su analizirani nalazi 224 bolesnika (252 noge) u kojih je učinjena revaskularizacija. Uspoređivani su nalazi doplera arterija sa nalazima DSA, te sa nalazima intervencije ili operacije. Usporedba je provedena na tri anatomska arterijska segmenta (aortoilijačni, femoropoplitealni i popliteokruralni), adekvatno skorirana, te potom obrađena Kappa statističkom analizom. Analizirana je podudarnost nalaza doplera sa svim uspoređivanim nalazima, na pojedinim arterijskim segmentima. Rezultati su ukazali na dobru podudarnost doplera sa svim uspoređivanim nalazima jedino na femoropoplitealnome segmentu, dok je aortoilijačno dobivena dobra podudarnost samo distalno od lezije, a popliteokruralno proksimalno i u nivou lezije. Zaključno, dostatnost doplera pri planiranju revaskularizacije dokazana je jedino na femoropoplitealnome segmentu. Na ostala dva anatomska segmenta, dopler samo iznimno može biti dostatan, stoga je i dalje DSA zlatni dijagnostički standard. U drugome dijelu ovoga rada, provedena je cost-effective analiza iz dobivenih rezultata retrospektivne studije. Naime, ukoliko bi se DSA izostavila kod dijagnostičke obrade prije revaskularizacije na femoropoplitealnom segmentu, nameće se pitanje financijske uštede. Razlika cijene koštanja nalaza doplera prema DTP-u i cijene koštanja DSA prema DTS-u, u 118 bolesnika sa femoropoplitealnom revaskularizacijom, donijela bi uštedu od 717.103,70 kn. Ušteda bi vjerojatno bila i veća, jer bi prema rezultatima iz retrospektivne studije, u pojedinim slučajevima bilo moguće koristiti dopler kao isključivu dijagnostičku pretragu i kod revaskularizacije na aortoilijačnom te popliteokruralnom segmentu.

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