Arterial Duplex Ultrasound is the Most Cost-Effective, Noninvasive Diagnostic Imaging Modality before Treatment of Lower-Extremity Arterial Occlusive Disease

Abstract

Introduction Multiple noninvasive imaging modalities (duplex ultrasound, magnetic resonance angiography, and computed tomographic angiography) are now available for diagnostic evaluation of lower-extremity arterial occlusive disease (LEOD). This study was performed to determine the effectiveness of duplex ultrasound as the primary diagnostic imaging test before endovascular treatment and to estimate the potential cost-savings compared with the use of other technologies. Methods The diagnostic evaluations of all patients treated for LEOD by a single vascular specialist between July 2004 and February 2008 were reviewed. The medical records were reviewed for the initial noninvasive diagnostic imaging study, type of intervention, and patency of revascularization. Medicare reimbursement rates (2007) for each imaging modality were used to compare costs of diagnostic testing. Results A total of 128 endovascular interventions were performed in 89 patients. Arterial duplex imaging was the primary and only diagnostic study performed prior to endovascular treatment in 108 (84%) of procedures. If preintervention magnetic resonance angiography or computed tomographic angiography had been used in these patients instead of duplex, the costs for diagnostic imaging alone would have increased by $96,064 and $44,762, respectively. Conclusion Arterial duplex ultrasound can be effectively used as the preferred modality for noninvasive imaging of LEOD, resulting in substantial cost savings.