Indications for endovascular dilatation in arterial occlusive diseases of the limbs

Nearest and long-term results of rentgen-endovascular dilatation in obliterating lesions of extremity arteries were studied in 74 patients. The authors believe rentgen-endovascular dilatation to be performed according to the following indications: 1. Stenoses and segment occlusions not longer than 5 cm with intact patency of the arteries in portions distal and proximal to the obliteration; 2. Stenoses of iliac arteries with altered femoral and popliteal arteries requiring operative measures and stenoses of the femoro-popliteal segments against the background of an obliterating lesion of the iliac arteries amendable to operative measures only; 3. Combination of stenosis or occlusion with unsatisfactory blood flow in the distal bed not corrected operatively; 4. Stenoses and occlusions not longer than 12-15 cm with elevated risk of operation; 5. Stenoses revealed after a successful course of thrombolytic therapy.     

Limitations of ultrasonic duplex scanning for diagnosing lower limb arterial stenoses in the presence of adjacent segment disease

Purpose: The purpose of this study was to provide a quantitative evaluation of the effect of adjacent segment lesions on disease classification in lower limb arteries by ultrasonic duplex scanning.Methods: Lower limb arterial duplex scanning from the distal aorta to the popliteal artery was performed in 55 patients. Arterial lesions evaluated by visual interpretation of Doppler spectra were compared blindly with those measured by angiography.Results: To recognize severe stenoses (50% to 100% diameter reduction) in any arterial segment, duplex scanning had sensitivity and specificity rates of 74% and 96%, respectively. However, sensitivity and specificity rates increased to 80% and 98%, respectively, when there was no 50% to 100% diameter-reducing lesion in adjacent segments, whereas they decreased to 66% and 94%, respectively, when there was at least one 50% to 100% diameter-reducing lesion in adjacent segments. Moreover, among the 48 duplex misclassifications underestimating or overestimating the degree of arterial stenoses, 30 (62.5%) involved a segment with at least one 50% to 100% lesion in adjacent segments. The segments mostly affected by proximal and distal arterial lesions were the popliteal arteries and the common and deep femoral arteries, where it was found that 86% (24/28) of the misclassifications involved the presence of either proximal or distal severe stenoses.Conclusion: The results demonstrated that the presence of multiple stenoses was an important limitation of duplex scanning for the detection and quantification of lower limb arterial disease. (J VASC SURG 1994;19:650-7.)     

Cycling related common femoral artery disease: an unusual case in an otherwise healthy male

A cyclist reported gradual onset, bilateral leg claudication without any atherosclerotic risk factors and with a normal vascular examination. Duplex ultrasound and magnetic resonance angiography revealed bilateral focal stenoses due to coralline plaques of the common femoral arteries (CFAs) but normal proximal and distal vasculature. A surgical endarterectomy with vein patch angioplasty resolved all symptoms. Cyclist's iliac syndrome (whereby mechanical and anatomical factors in competitive cyclists and runners lead to arterial kinking and subsequent intimal hyperplasia, endofibrosis and, ultimately, stenoses of the external iliac arteries) is well documented. This is the first report to our knowledge of a similar process isolated to the CFA.     

Magnetic resonance imaging: a reliable test for the evaluation of proximal atherosclerotic renal arterial stenosis

Symptomatic renal artery stenosis is a significant and treatable clinical problem. A reliable and accurate noninvasive method of screening for renal artery stenosis has not yet been found. We used magnetic resonance imaging to study 37 patients who had undergone recent renal angiography. Fourteen patients had normal renal arteries by angiography. In 23 patients either unilateral or bilateral stenosis or occlusion was present. The disease process in all patients appeared to be atherosclerosis. The average age of the 37 patients was 68 years. The magnetic resonance scans and angiograms were read independently by two different radiologists, each of whom was blinded to the clinical history and the results of the other study. Renal arterial stenoses found on angiogram and magnetic resonance scans were graded as absent (0% to 24%), mild (25% to 49%), moderate (50% to 74%), or severe (75% to 99%). The magnetic resonance imaging results concurred with the angiographic findings in 70 of 77 arteries (91%). Magnetic resonance imaging predicted the presence of a greater than 50% stenosis of the renal artery with a sensitivity of 100% and a specificity of 94%. Magnetic resonance imaging may prove to be the best noninvasive screening test for proximal atherosclerotic renal arterial stenosis.     

Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity.

OBJECTIVES: Arteriographic lesions of diabetic subjects with critical limb ischemia (CLI) and ischemic foot ulcer were reviewed retrospectively, to provide new criteria for stratification of these patients on the basis of their vascular involvement. PATIENTS: In 417 consecutive CLI diabetic subjects with ischemic foot ulcer undergoing lower limb angiography, lesions were defined as stenosis or occlusion, localization, and length (<5 cm, 5-10 cm, >10 cm). In a subgroup of 389 subjects, foot arteries also were evaluated. Patients then were categorized into 7 classes of progressive vascular involvement based on angiographic findings. RESULTS: Of the 2893 found lesions (55% occlusions) 1% were in the iliac arteries, whereas 74% were in below-the-knee (BTK) arteries. Sixty-six % of all BTK lesions were occlusions, and 50% were occlusions >10 cm (p<0.001 vs proximal segments). Occlusions of all BTK were present in 28% of patients, although there was patency of at least one foot artery in 55% of patients. The morphologic Class 4 (two arteries occluded and multiple stenoses of tibial/peroneal and/or femoral/popliteal vessels) was the most common (36%). An inverse correlation between morphologic class and TcPO2 was observed (r=-0.187, p=0.003). CONCLUSIONS: In CLI diabetic subjects with ischemic foot ulcer, the vascular involvement is extremely diffuse and particularly severe in tibial arteries, with high prevalence of long occlusions. A new morphologic categorization of these patients is proposed.     

完全腹腔镜髂-股动脉人工血管旁路术一例

目的探讨完全腹腔镜髂-股动脉人工血管旁路术的可行性和安全性。方法 2010年5月收治外伤后髂动脉闭塞患者1例,行完全腹腔镜髂总动脉-股动脉人工血管旁路术。患者取仰卧位,脐部下缘10mm切口建立气腹与腹腔镜通道,另置入2个5mmTrocar和1个12mmTrocar导入操作器械。经腹腔入路,游离右髂总动脉。周身肝素化（1mg/kg）后阻断右髂总动脉,远端夹闭后离断。置入膨体聚四氟乙烯人工血管,在腹腔镜下行人工血管-右髂总动脉端端吻合术。吻合成功后,将人工血管经皮下隧道引出至右腹股沟切口。开放手术行人工血管-右股动脉端侧吻合。结果手术过程顺利,手术时间250min,术中髂总动脉阻断时间55min,吻合时间40min,术中失血量300ml。随访1年,人工血管通畅。结论完全腹腔镜髂-股动脉人工血管旁路术是安全、可行的。熟练的腹腔镜血管吻合技术是手术成功的关键。     

Proximal arterial occlusion protects the distal lower limb vessels.

PURPOSE: To test the hypothesis that chronic arterial occlusion protects the distal vessels from disease progression. METHODS: Peripheral angiograms from the radiology film store filed under 1997-1999 were reviewed. Those showing unilateral iliac occlusion and those showing unilateral femoro-popliteal occlusion were selected. The severity of arterial disease distal to the occlusion was compared with the patent side. Subsequently, in a subgroup of patients undergoing repeat angiography, the frequency and distribution of disease progression was recorded and related to the initial disease distribution. RESULTS: In the presence of a unilateral iliac occlusion, femoro-popliteal occlusion was less likely on the side of the iliac occlusion than on the opposite side (difference in proportion 10%. 95% C.I.: 1-18%). In the presence of a unilateral occlusion proximal to the knee joint, there were more patent calf vessels on the side of the occlusion than on the opposite side (difference in proportion 9%. 95% C.I.: 4-14%). When angiography was repeated, progression of calf vessel disease was less common in the limbs with untreated proximal occlusion than in those with no proximal occlusion. CONCLUSION: Proximal arterial occlusion protects the distal vessels from the risk of progressive arterial disease.     

Limitations of the femoral artery pulsatility index with aortoiliac artery stenosis: an experimental study

Relationships between femoral artery pulsatility index (PI) (a number calculated from Doppler-derived arterial blood velocity waveforms) and three directly measured physiologic parameters (proximal artery stenosis, blood pressure index (BPI), and blood flow) were studied in a canine model. All combinations of stenoses were constructed, including 0%, 25%, 50%, 75%, and 90% reduction in a cross-sectional area in the infrarenal aorta and/or left common iliac artery of 14 animals. PIs, BPIs, and mean blood flows were measured for each stenosis pattern at both the right (control) and left femoral arteries. Three groups were studied--group I, the left femoral artery remained open; group II, the left femoral artery was ligated; and group III, a left femoral arteriovenous fistula was constructed. Correlations between reductions in femoral artery PI and increasing arterial stenosis as well as decreasing BPI and blood flow were obtained. However, positive correlations were weak and only recognized when high-grade stenoses were present. Moreover, these correlations were further influenced by the multiplicity of stenoses present as well as flow velocity into the distal arterial bed. These data suggest that PI lacks the sensitivity to be a clinically useful diagnostic test.     

Percutaneous epiphyseodesis for treating limb length inequality in children --results after termination of growth]

Results of percutaneous epiphyseodesis for limb length egalization in 25 children (10 girls and 15 boys) after termination of growth are presented. Mean age at the surgery was 12.9 years (range 10.9-14.4 years), mean limb length discrepancy 4.3 cm (range 2-10 cm), mean follow-up was 50 months (range 14-86 months). In 17 cases distal femoral epiphyseodesis was done, in 7 cases distal femoral, proximal tibial and fbular and in 1 case only proximal tibial and fibular epiphyseodesis was performed. In 13 cases CT served to assess the area of removed physis. Among complications knee hemarthrosis was encountered twice and once subcutaneous hematoma of the lower leg occurred. At the final follow-up full range of motion in the knee and correct axial alignment was observed in all cases. Residual limb length discrepancy was 1.3 cm (range 0-4 cm). Between 20 and 60% of total area of the physis was destroyed. Yearly rate of femoral bone growth inhibition was the same in patients with 27% and 40% of physis removed.     

Influence of prazosin on experimental vein graft intimal thickening.

The influence of prazosin on experimental vein graft intimal thickening was studied in a rat model. The iliolumbar vein was grafted into the common iliac artery in a prazosin-treated group (n = 17) and a control group (n = 23). Three weeks after grafting the animals were killed and the grafts harvested. Longitudinal sections were prepared and the intimal thickness measured in the proximal, mid and distal graft. Intimal thickness varied considerably in both groups. Median (range) intimal thicknesses for the control group were: proximal 50 (10-120) microns; mid 30 (10-70) microns; and distal graft 30 (10-100) microns. Results for the prazosin-treated group were: proximal 70 (10-160) microns; mid 25 (5-60) microns; and distal graft 25 (5-135) microns. There was no statistically significant difference in median intimal thicknesses between the control and treated groups.     

Regional differences in ultrasonic assessment of subcutaneous fat thickness in the abdomen: effects on the TRAM flap

The authors describe the results of fat thickness patterning of the abdominal sites in 50 patients, all of whom required breast reconstruction with a transverse rectus abdominis musculocutaneous flap. The thickness of the abdominal fat was measured at 12 anatomic locations with an ultrasonic instrument. The highest value of the subcutaneous fat thickness was 29.0+/-10.0 mm at a site 2 cm below the umbilicus at the center of the rectus abdominis muscle. The lowest value of the subcutaneous fat thickness was 17.8+/-7.6 mm at a site 2 cm above the umbilicus on the anterior superior iliac spine. Average subcutaneous fat thickness over the abdomen of 50 patients was 24.0+/-9.4 mm. There were 13 patients (group 1) who had an abdominal fat thickness of more than 30 mm, 19 patients (group 2) with an abdominal fat thickness less than 30 mm and more than 20 mm, and 18 patients (group 3) with an abdominal fat thickness less than 20 mm. Complications occurred in 12 of 50 flaps (24%). Among groups 1, 2, and 3 there was no significant difference (p<0.01) in the overall flap complications (15.4: 36.8: 16.7). In summary, subcutaneous fat thickness showed the higher value at the center of the abdomen and the lower value at the lateral site. Abdominal fat thickness is not a risk factor for necrosis of pedicled transverse rectus abdominis musculocutaneous flaps in patients who are thin, average, or mildly obese. Preoperative examination of the abdominal subcutaneous fat thickness should provide useful information for detailed simulation of a reconstructive operation.     

Long-term results after endovascular treatment of peripheral arterial occlusions

OBJECTIVE: Presentation of our long-term results with endovascular treatment of peripheral arterial occlusive disease. PATIENTS AND METHODS: We report on 115 patients (98 male, 17 female), average 67 years, with 141 occlusions or stenoses in the iliac or femoral arteries that were treated by laser-angioplasty. RESULTS: Excellent primary results were obtained in 93 % of the stenoses and 74 % of the occlusions. The results depended on the length of the lesions. In femoro-popliteal lesions < 10 cm length a success rate of 98 % could be observed, in lesions > 10 cm it was 71 %. The same was true for iliac lesions: the clinical success rate was 91 % in lesions < 5 cm as compared to 44 % in lesions > 5 cm.The long-term results were even satisfactory, the patency rate ranged to 85 % in stenoses and 75 % in occlusions, resp. CONCLUSION: Laser-angioplasty in our hands is an excellent treatment modality for occlusions/stenoses of the peripheral arteries and coronaries, a strong indication anticipated.     

Common iliac artery stenosis presenting as renal allograft dysfunction in two diabetic recipients

BACKGROUND: Suprarenal common iliac artery stenosis is an uncommon but reversible cause of allograft dysfunction in renal transplant recipients. METHOD: We describe two diabetic renal transplant recipients with worsening hypertension, edema, and azotemia. Magnetic resonance angiography (MRA) demonstrated tight stenoses in the common iliac artery proximal to the allograft anastomosis site with patent renal transplant artery in both cases. These findings were later confirmed with carbon dioxide angiography. RESULTS: No acute rejection was noted on renal biopsy in either case. Placement of percutaneous iliac artery Wallstents resulted in decrease of serum creatinine from 6.5 to 2.0 mg/dl and 1.7 to 1.0 mg/dl within 2 and 4 weeks, respectively. CONCLUSION: Common iliac artery stenosis should be suspected in renal transplant recipients presenting with worsening hypertension, edema and azotemia. MRA for screening followed by carbon dioxide angiography and placement of intravascular stents for focal vascular obstructive lesions reverses allograft dysfunction.     

Internal iliac artery revascularization as an adjunct to endovascular repair of aortoiliac aneurysms.

PURPOSE: Endovascular repair of aortoiliac aneurysms may be limited by extension of the aneurysm to the iliac bifurcation, necessitating endpoint implantation in the external iliac artery. In such cases the circulation to the internal iliac artery is interrupted. Bilateral internal iliac artery occlusion during endovascular repair may be associated with significant morbidity, including gluteal claudication, erectile dysfunction, and ischemia of the sigmoid colon and perineum. We have employed internal iliac artery revascularization (IIR) to allow endograft implantation in the external iliac artery while preserving flow to the internal iliac artery in patients with aneurysms involving the iliac bifurcation bilaterally. METHODS: A total of 11 IIR procedures were performed in 10 patients undergoing endovascular abdominal aortic aneurysm (AAA) repair (9 men, 1 woman; mean age, 74 years). IIR was accomplished via a retroinguinal incision in 9 cases and a retroperitoneal incision in 2 cases. Six-mm polyester grafts were used for external-to-internal iliac artery bypass in 10 cases and internal iliac artery transposition onto the external iliac artery was used in one case. Endovascular AAA repair was performed using a modular bifurcated device (Talent-LPS, Medtronics, Minneapolis, Minn) after IIR. Bypass graft patency was determined immediately after the surgery, at 1 month, and every 3 months thereafter, using duplex ultrasound scanning and computed-tomography angiography. Mean aneurysm diameters were as follows: AAA, 6.4 +/- 0.7 cm; ipsilateral common iliac, 3.7 +/- 1.0 cm; contralateral common iliac, 3.9 +/- 0.8 cm. RESULTS: Successful IIR and endovascular AAA repair were accomplished in all cases. No proximal, distal, or graft junction endoleaks occurred. Two patients demonstrated retrograde aneurysm side-branch endoleaks originating from the lumbar arteries. One thrombosed spontaneously within 3 months. One perioperative myocardial infarction occurred. Reduction in aneurysm size was documented in 5 aortic, 5 ipsilateral iliac, and 3 contralateral iliac aneurysms. Gluteal claudication, erectile dysfunction, colon and perineal ischemia, and mortality did not occur. All IIRs have remained patent during a follow-up period of 4 to 15 months (mean, 10.1 months). CONCLUSIONS: IIR may be used with good short-term to intermediate-term patency to prevent pelvic ischemia in patients whose aneurysm anatomy requires extension of the endograft into the external iliac artery. This may allow endovascular AAA repair to be performed in patients who might otherwise be at risk for developing complications associated with bilateral internal iliac artery occlusion.     

Technical tips for endovascular repair of common iliac artery aneurysms

Isolated common iliac artery aneurysms are rare, comprising <2% of all aneurysm disease. These aneurysms present as either isolated disease, .03% of the population, or, in conjunction with abdominal aortic aneurysm, in approximately 20% to 25% of such cases. Common iliac artery aneurysms are defined as any localized dilatation of the common iliac artery >1.5 cm in diameter. Elective repair for isolated common iliac artery aneurysms is generally not undertaken for aneurysms <3 cm in diameter unless they are part of an abdominal aortic aneurysm repair. Most common iliac artery aneurysms are found incidentally during abdominal/pelvic diagnostic imaging studies or at the time of pelvic or abdominal surgery. As with abdominal aortic aneurysms, endovascular repair of common iliac artery aneurysms follows techniques similar to those used for endovascular repair of abdominal aortic aneurysm. Management includes aneurysm exclusion with an endograft, which seals at sites within the proximal and distal common iliac artery and may involve coil occlusion of the hypogastric artery with extension of the reconstruction into the proximal external iliac artery, or use a "bell-bottom" endograft limb placed at the common iliac bifurcation. Technical tips for successful outcome are described here, and all US Food and Drug Administration approved endografts have been used for repair. There were no statistically significant differences in outcomes that correlated with device or repair techniques used for management of common iliac artery aneurysms. Mid-term 54-month outcome has been excellent, with no common iliac artery ruptures or aneurysm-related deaths and the need for secondary interventions was gratifyingly small.     

Preliminary results of Anaconda aortic endografts: a single center study.

OBJECTIVE: To evaluate the peri-operative results of Anaconda endograft in the first 49 cases treated in a single centre. METHODS: The study was carried out prospectively on cases of infrarenal abdominal aortic aneurysm (AAA) treated with Anaconda endograft. The characteristics of the proximal aortic neck and of the iliac access vessels were considered. The following operative results were assessed: the main body oversizing, the need to correct the positioning of the main body, the use of iliac extensions, the use of ballooning, the covering of patent hypogastric arteries, the presence of endoleaks and the need for conversion. Peri-operative (30 days) mortality and morbidity were also considered. RESULTS: Of the 49 cases treated, 44 were males with a mean age of 73 years (range: 55-89 yrs; SD+/-7 yrs). The mean diameter of the AAA was 56 mm (range 45-91 mm; SD+/-11); 4 cases had common iliac aneurysms with a diameter >3 cm. The mean neck diameter and length were 23 mm (range 19-28 mm; SD+/-3) and 25 mm (range 15-50 mm; SD+/-10) respectively. An aortic neck angle between 40 degrees and 70 degrees was present in 10 cases (20%) (mean 58 degrees; SD+/-15 degrees), and 20 cases (41%) had iliac tortuosity with an angle greater than 60 degrees (mean 85 degrees; SD+/-25 degrees). There were no cases of conversion or intra-operative death. One (2%) peri-operative death occurred, for reasons not related to the endograft. There were two cases of iliac limb thrombosis. CT at one month showed 12 cases (25%) of type II endoleak. There were no cases of type I or type III endoleaks. CONCLUSIONS: The preliminary data of this series demonstrates that the Anaconda endograft has good peri-operative results in the treatment of infrarenal AAAs with a neck length not less than 15 mm.     

Comparison of contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities

Color flow duplex scanning was used to "map" the iliofemoral and femoral popliteal segments in 61 patients (84 extremities) undergoing evaluation for excimer laser angioplasty. Eight locations, iliac, common femoral, profunda femoris, proximal and distal superficial femoral artery, proximal and distal popliteal, and tibioperoneal trunk were scored as normal versus abnormal, greater than 50% stenosis, or occluded, and occlusions were measured in centimeters. Specificity, sensitivity, and accuracy were calculated with the arteriogram as the gold standard (83% and 96%, respectively, for normal vs abnormal, 87% and 99% for 50% stenosis, and 81% and 99% for occlusions). Color flow accurately identified the presence and extent of occlusions in 48 of 51 extremities (94%) when compared to arteriography plus operative findings, since arteriography alone tended to overestimate occlusion length. It is concluded that color flow Doppler alone may be used to screen patients with peripheral vascular disease to assess candidacy for endovascular procedures without antecedent arteriography, and that arteriography alone would exclude some patients from consideration by falsely overestimating occlusion lengths.     

In vitro evaluation of multiple arterial stenoses using three-dimensional power Doppler angiography

Purpose: The study was done to improve quantification of multiple arterial stenoses and to investigate a new imaging technique for lower limb arteries. Three-dimensional power Doppler angiography was used to quantify in vitro arterial stenoses. Methods: We built two types of artery phantoms containing multiple stenoses. One used stenotic porcine arteries, and the other was designed to control the proximal and distal stenoses while we assessed central stenosis of a wall-less agar lumen. Three-dimensional power Doppler angiograms of the flow lumens were generated at different flow rates under steady and pulsatile flow conditions with a PowerPC 8500 computer-based three-dimensional ultrasound imaging system. This experimental system works off-line, performs three-dimensional acquisition, reconstruction, and display of ultrasound images. Images of flow lumens were compared with the measured B-mode images or the true geometry. Results: This technique produces good three-dimensional angiographic images of the flow lumen, and multiple stenoses do not affect the diagnosis of arterial stenoses. With this technique, the average errors for estimating 80% and 50% area reduction stenoses were –10% and –4%, respectively. Conclusions: Three-dimensional power Doppler angiography has the potential to quantitatively grade multisegmental stenoses in lower limbs and generate a map for vasculature surgery planning. (J Vasc Surg 1998;27:681-8.)     

Stenting for localised arterial stenoses in the aorto-iliac segment.

OBJECTIVE: to determine complications and patency following angioplasty (PTA) and stenting of aorto-iliac stenoses. Setting: District General Hospital in U.K. Design: prospective observational study. PATIENTS AND METHODS: between December 1994 and June 2000, 50 patients (38 men), median age 64 (41-89) years underwent aorto-iliac stenting. A total of 61 stents were placed. Indications were intermittent claudication in 38 and rest pain, ulceration or gangrene in 12. Sites stented were aorta 11, common iliac artery 32, external iliac artery 14, common and external iliac arteries two. Bilateral iliac procedures were carried out in nine. Two stents were used to correct residual stenoses after aortic stenting. Some 11 recurrent stenoses were treated. The other reasons for stenting were residual stenoses greater than 30% after PTA, tight calcified stenoses or when a stenosed iliac artery was being used as a donor prior to crossover or femoropopliteal bypass. RESULTS: two immediate technical failures occurred due to malposition. Residual stenoses were corrected by PTA. Two further patients sustained minor complications. None of the aortic stents occluded through two required secondary procedures. Primary-assisted patency was thus 100% at three years. Primary patency following iliac stenting for claudication and critical ischaemia were 97% and 86% at three years respectively. CONCLUSION: PTA and stenting of aorto-iliac stenoses can be safely achieved with durable results.     

Improved assessment of the hemodynamic significance of borderline iliac stenoses with use of hyperemic duplex scanning

OBJECTIVE: To improve the assessment of the hemodynamic significance of borderline iliac stenoses (stenosis with a peak systolic velocity [PSV] ratio between 1.5 and 3.5) by means of hyperemic duplex scanning. The duplex ultrasound parameter-absolute increase in PSV across the stenosis after exercise (Delta PSV(e))-was studied prospectively. PATIENTS AND METHODS: Fifty-eight legs in 53 consecutive patients with symptomatic arterial obstructive disease with borderline iliac stenosis were studied prospectively. Ultrasound velocity data collected after exercise on a bicycle ergometer at 2 W/kg during 2 minutes were judged against the assessment of the hemodynamic significance by means of intraarterial pressure measurement, before and after the administration of 50 mg papaverine. RESULTS: On the basis of receiver operating characteristic curves traced for 43 iliac stenoses in 39 patients who finished the exercise, Delta PSV(e) > or = 1.4 m/s had optimal sensitivity of 93% (95% confidence interval [CI],.77-.99), specificity of 87% (95% CI,.60-.98), positive predictive value of 93% (95% CI,.77-.99) and negative predictive value of 87% (95% CI,.60-.98). CONCLUSIONS: The results of this study show that Delta PSV(e) with a cutoff value of 1.4 m/s in combination with the PSV ratio improves the assessment of the hemodynamic significance of borderline iliac artery stenoses if the patient can accomplish the workload.