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Original article

Vol. 143 No. 0910 (2013)

Predictive value of auscultation of femoropopliteal arteries

  • Carla Kaufmann
  • Vincenzo Jacomella
  • Ludmila Kovacicova
  • Marc Husmann
  • Robert K. Clemens
  • Christoph Thalhammer
  • Beatrice R. Amann-Vesti
DOI
https://doi.org/10.4414/smw.2013.13761
Cite this as:
Swiss Med Wkly. 2013;143:w13761
Published
24.02.2013

Summary

Summary

BACKGROUND: Femoropopliteal bruits indicate flow turbulences and increased blood flow velocity, usually caused by an atherosclerotic plaque or stenosis. No data exist on the quality of bruits as a means for quantifying the degree of stenosis. We therefore conducted a prospective observational study to investigate the sensitivity and specificity of femoropopliteal auscultation, differentiated on the basis of bruit quality, to detect and quantify clinically relevant stenoses in patients with symptomatic and asymptomatic peripheral arterial disease (PAD).

METHODS: Patients with known chronic and stable PAD were recruited in the outpatient clinic. We included patients with known PAD and an ankle-brachial index (ABI) <0.90 and/or an ABI ≥0.90 with a history of lower limb revascularisation. Auscultation was performed independently by three investigators with varied clinical experience after a 10-minute period of rest. Femoropopliteal lesions were classified as follows: normal vessel wall or slight wall thickening (<20%), atherosclerotic plaque with below 50% reduction of the vessel lumen, prestenotic/intrastenotic ratio over 2.5 (<70%), over 3.5 (<99%) and complete occlusion (100%).

RESULTS: Weighted Cohen’s κ coefficients for differentiated auscultation were low in all vascular regions and did not differ between investigators. Sensitivity was low in most areas with an increase after exercise. The highest sensitivity in detecting relevant (>50%) stenosis was found in the common femoral artery (86%).

CONCLUSION: Vascular auscultation is known to be of great use in routine clinical practice in recognising arterial abnormalities. Diagnosis of PAD is based on various diagnostic tools (pulse palpation, ABI measurement) and auscultation can localise relevant stenosis. However, auscultation alone is of limited sensitivity and specificity in grading stenosis in femoropopliteal arteries. Where PAD is clinically suspected further diagnostic tools, especially colour-coded duplex ultrasound, should be employed to quantify the underlying lesion.

References

  1. Diehm C, Allenberg JR, Pittrow D, et al. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation. 2009;120:2053–61.
  2. Criqui MH, Fronek A, Barrett-Connor E, et al. The prevalence of peripheral arterial disease in a defined population. Circulation. 1985;71:510–5.
  3. Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med. 2001;344:1608–21.
  4. Khan NA, Rahim SA, Anand SS, Simel DL, Panju A. Does the clinical examination predict lower extremity peripheral arterial disease? JAMA. 2006;295:536–46.
  5. Criqui MH, Fronek A, Klauber MR, Barrett-Connor E, Gabriel S. The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. Circulation. 1985;71:516–22.
  6. Carter SA. Arterial auscultation in peripheral vascular disease. JAMA. 1981;246:1682–6.
  7. Rooke TW, Hirsch AT, Misra S, et al. 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2011;58:2020–45.
  8. McPhail IR, Spittell PC, Weston SA, Bailey KR. Intermittent claudication: an objective office-based assessment. J Am Coll Cardiol. 2001;37:1381–5.
  9. Ranke C, Creutzig A, Alexander K. Duplex scanning of the peripheral arteries: correlation of the peak velocity ratio with angiographic diameter reduction. Ultrasound Med Biol. 1992;18:433–40.
  10. Hatsukami TS, Primozich JF, Zierler RE, Harley JD, Strandness DE, Jr. Color Doppler imaging of infrainguinal arterial occlusive disease. J Vasc Surg. 1992;16:527–31; discussion 531-523.
  11. Sauve JS, Thorpe KE, Sackett DL, et al. Can bruits distinguish high-grade from moderate symptomatic carotid stenosis? The North American Symptomatic Carotid Endarterectomy Trial. Ann Intern Med 1994;120:633–7.
  12. Ratchford EV, Salameh MJ, Morrissey NJ. Underestimation of carotid stenosis in bradycardia. Vascular. 2009;17:51–4.
  13. Cournot M, Boccalon H, Cambou JP, et al. Accuracy of the screening physical examination to identify subclinical atherosclerosis and peripheral arterial disease in asymptomatic subjects. J Vasc Surg. 2007;46:1215–21.
  14. McLoughlin MJ, Colapinto RJ, Hobbs BB. Abdominal bruits. Clinical and angiographic correlation. JAMA. 1975;232:1238–42.
  15. Thalhammer C, Aschwanden M, Amann-Vesti BR. “The seagull cry”: a sign of emergency after renal transplantation? Circulation. 2010;121:e25–26.
  16. Thalhammer C, Aschwanden M, Husmann M, et al. Clinical relevance of musical murmurs in color-coded duplex sonography of peripheral and visceral vessels. Vasa. 2011;40:302–7.

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