Improved assessment of the hemodynamic significance of borderline iliac stenoses with use of hyperemic duplex scanning

Objective: To improve the assessment of the hemodynamic significance of borderline iliac stenoses (stenosis with a peak systolic velocity [PSV] ratio between 1.5 and 3.5) by means of hyperemic duplex scanning. The duplex ultrasound parameter-absolute increase in PSV across the stenosis after exercise (DeltaPSV(c))-was studied prospectively. Patients and Methods: Fifty-eight legs in 53 consecutive patients with symptomatic arterial obstructive disease with borderline iliac stenosis were studied prospectively. Ultrasound velocity data collected after exercise on a bicycle ergometer at 2 W/kg during 2 minutes were judged against the assessment of the hemodynamic significance by means of intraarterial pressure measurement, before and after the administration of 50 mg papaverine. Results: On the basis of receiver operating characteristic curves traced for 43 iliac stenoses in 39 patients who finished the exercise, DeltaPSV(c) greater than or equal to1.4 m/s had optimal sensitivity of 93% (95% confidence interval [CI], .77-.99), specificity of 87% (95% CI, .60-.98), positive predictive value of 93% (95% CI, 77-.99) and negative predictive value of 87% (95% CI, 60-.98). Conclusions: The results of this study show that DeltaPSV(c) with a cutoff value of 1.4 m/s in combination with the PSV ratio improves the assessment of the hemodynamic significance of borderline iliac artery stenoses if the patient can accomplish the workload