| Abstract | Zlatni dijagnostički standard kod periferne arterijske bolesti je godinama bila DSA. Međutim,
radi se o invazivnoj metodi, koja je skupa i vezana za potencijalne brojne komplikacije.
Uporaba doplera kao neinvazivne dijagnostičke metode pruža mnogo kvalitetnih informacija,
potencijalno dostatnih za planiranje revaskularizacije kod periferne arterijske bolesti.
U prvome dijelu ovoga istraživanja provedena je retrospektivna studija kojom su analizirani
nalazi 224 bolesnika (252 noge) u kojih je učinjena revaskularizacija. Uspoređivani su nalazi
doplera arterija sa nalazima DSA, te sa nalazima intervencije ili operacije. Usporedba je
provedena na tri anatomska arterijska segmenta (aortoilijačni, femoropoplitealni i
popliteokruralni), adekvatno skorirana, te potom obrađena Kappa statističkom analizom.
Analizirana je podudarnost nalaza doplera sa svim uspoređivanim nalazima, na pojedinim
arterijskim segmentima. Rezultati su ukazali na dobru podudarnost doplera sa svim
uspoređivanim nalazima jedino na femoropoplitealnome segmentu, dok je aortoilijačno
dobivena dobra podudarnost samo distalno od lezije, a popliteokruralno proksimalno i u nivou
lezije. Zaključno, dostatnost doplera pri planiranju revaskularizacije dokazana je jedino na
femoropoplitealnome segmentu. Na ostala dva anatomska segmenta, dopler samo iznimno
može biti dostatan, stoga je i dalje DSA zlatni dijagnostički standard.
U drugome dijelu ovoga rada, provedena je cost-effective analiza iz dobivenih rezultata
retrospektivne studije. Naime, ukoliko bi se DSA izostavila kod dijagnostičke obrade prije
revaskularizacije na femoropoplitealnom segmentu, nameće se pitanje financijske uštede.
Razlika cijene koštanja nalaza doplera prema DTP-u i cijene koštanja DSA prema DTS-u, u
118 bolesnika sa femoropoplitealnom revaskularizacijom, donijela bi uštedu od 717.103,70
kn. Ušteda bi vjerojatno bila i veća, jer bi prema rezultatima iz retrospektivne studije, u
pojedinim slučajevima bilo moguće koristiti dopler kao isključivu dijagnostičku pretragu i
kod revaskularizacije na aortoilijačnom te popliteokruralnom segmentu. |
| Abstract (english) | For years DSA has been the golden standard in peripheral arterial disease. However, it is an
invasive and costly method, associated with numerous potential complications. As a
noninvasive diagnostic method Doppler offers quite a few valuable information, potentially
sufficient for planning revascularisation in patients suffering from peripheral arterial disease.
The first part of this study involved the analysis of findings on 224 patients (252 legs) who
had undergone revascularisation. Arterial Doppler findings were compared with DSA and
intrainterventional/intraoperative findings. The comparison was carried out on three
anatomical arterial segments, i.e., the aortoiliac, femoropopliteal and popliteocrural segments.
It was appropriately scored and subsequently processed by Kappa statistical analysis. The
agreement of Doppler findings with the compared findings on specific arterial segments was
analysed. The results showed a good Doppler agreement with the compared findings only on
the femoropopliteal segment. On the aortoiliac segment agreement was good only distally
from the lesion, and on the popliteocrural segment proximally and at the level of the lesion.
Conclusively, the sufficiency of Doppler in planning revascularisation has only been
demonstrated on the femoropopliteal segment. On the other two anatomical segments Doppler
can be sufficient only exceptionally, which still leaves DSA as the golden standard. The
second part of the study focused on the cost-effectiveness analysis based on the results
obtained in the retrospective study. That is, if DSA were omitted in diagnosis before
revascularisation on the femoropopliteal segment, the issue of financial savings comes up.
The difference between the cost price of Doppler according to DTP and the cost price of DSA
according to DTG in 118 patients with femoropopliteal revascularisation would imply savings
in the amount of Hrk 717,103.70. The savings could probably be even higher because, as
shown by the results of the retrospective study, in some cases Doppler could also be used as
the exclusive diagnostic tool in revascularisation on the aortoiliac and politeocrural segments. |
