Predictive values of risk factors in carotid duplex scanning before peripheral vascular surgery

Abstract

The objective of this study was to determine the predictive values of multiple atherosclerotic risk factors in using routine carotid duplex scanning for patients with peripheral vascular disease, even in the absence of any sign of carotid disease. From 1998 through 2000, 108 patients admitted for peripheral vascular reconstruction to our institution were preoperatively screened for carotid artery stenosis. Patients were examined for neurologic status and cervical bruits. As atherosclerotic risk factors, hyperlipidemia, diabetes, smoking, sex and age, coronary artery disease (CAD), coronary artery bypass surgery (CABG), and previous vascular operation were recorded, preoperative ankle-brachial pressure indexes (ABI) were calculated. All patients underwent routine carotid color duplex examinations preoperatively. Eighty five patients (78.7%) had mild (< 50%) or no carotid artery stenosis, and 23 patients (21.3%) had significant (≥ 50%) carotid artery stenosis. Age (≥ 60 years), coronary artery disease, and carotid bruit were individual factors, and the combination of age ≥ 55 and hyperlipidemia had a significant value in predicting presence of ≥ 50% stenosis of one or both carotid arteries by univariate analysis. By multivariate logistic regression analysis, however, only carotid bruit was associated with carotid artery stenosis of ≥ 50% (p < 0.001). Screening for asymptomatic carotid artery stenosis is indicated in patients with only carotid artery bruit and might be indicated in elderly patients with peripheral vascular disease. Routine screening or carotid artery stenosis in all patients is not an effective strategy.