Consensus non-invasieve diagnostiek van perifere arteriële vaatziekte

– The outcome is described of a 1993 consensus meeting regarding the role and value of functional non-invasive vascular investigations in the assessment of severity and localization of arterial obstructions and in the selection of a therapeutic strategy in patients with arterial obstructive disease of the lower extremities. Since symptoms and clinical investigation alone are unreliable in assessing the severity of peripheral arterial disease, complementary functional vascular examinations are needed. Measurement of the systolic blood pressures at ankle level by means of a sphygmomanometric method and a Doppler flowmeter allows reliable determination of the presence or absence of haemodynamically significant arterial obstructions. In the case of minor obstructions the sensitivity of ankle pressure measurements can be increased by examination during a period of hyperaemia, preferably induced by a treadmill walking test. In the case of unreliable ankle pressure measurements due to non-compressible arteries determination of the toe blood pressure is indicated. Segmental blood pressure measurements as well as Doppler analysis of the blood flow at various levels of the leg were not considered reliable enough for the localization of arterial obstructions, unless the obstructive disease is restricted to one single arterial segment. Accurate non-invasive localization of arterial obstructions and the determination of their haemodynamic severity are only possible by means of a combined echo-Doppler (duplex) examination of the arteries. Duplex examination can also be helpful in choosing between surgery and percutaneous transluminal angioplasty of localised stenoses and short occlusions.