Can common femoral artery doppler waveform analysis reliably predict haemodynamically significant disease of the aorto-Iliac arteries? A systematic review and meta-analysis

Fabre, Ismay, Gwilym, Brenig Llwyd, Kabis, Mohamed, Thomas, William Rhodri, Bryant, Catherine, White, Richard D. and Bosanquet, David Charles 2025. Can common femoral artery doppler waveform analysis reliably predict haemodynamically significant disease of the aorto-Iliac arteries? A systematic review and meta-analysis. Annals of Vascular Surgery 10.1016/j.avsg.2025.04.064

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Abstract

Introduction: Many guidelines recommend duplex scanning as the first-line investigation for peripheral arterial disease. Qualitative evaluation of the common femoral artery (CFA) waveform provides information regarding the likely presence of significant aorto-iliac disease. Certain centres employ a ‘triphasic-and-down’ policy, proceeding directly to antegrade endovascular intervention of infra-inguinal disease if the CFA-waveform is triphasic. Others mandate cross-sectional imaging regardless of CFA-waveform, to exclude occult aorto-iliac disease. This review aims to analyse the reliability of CFA-waveform in excluding significant aorto-iliac disease. Methods: Medline, Embase, Cochrane library and reference lists were searched for studies comparing CFA-waveform analysis with reference tests assessing aorto-iliac disease. Triphasic waveforms were considered “normal”, whilst biphasic/monophasic were considered “abnormal”. Meta-analyses using a bivariate model produced pooled diagnostic accuracy metrics including negative and positive predictive values, sensitivity and specificity. Results: Eight studies with 1139 limbs were included. Where reported, mean age was 67, 64.4% had claudication and 35.6% critical limb ischaemia, 42.3% were smokers and 33.3% diabetic. Reference investigations were catheter or cross-sectional angiography(n=5), aorto-iliac duplex(n=2), and intra-arterial pressures(n=1). The pooled NPV was 84.7% (95%CI: 59.3%-97.0%) meaning a triphasic waveform correctly excludes significant aorto-iliac disease 84.7% of the time, and PPV was 71.3% (95%CI: 36.1%-93.1%). Sensitivity was 0.86 (95%CI: 0.78-0.92), indicating 14% of patients with significant aorto-iliac disease had triphasic waveforms, and specificity was 0.78 (95%CI: 0.61-0.89). Conclusions: The best data available suggests Doppler waveform analysis lacks precision in identifying and excluding significant aorto-iliac disease compared to heterogenous reference tests. A low threshold for cross-sectional imaging prior to antegrade endovascular intervention may be appropriate.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Medicine
Additional Information:	License information from Publisher: LICENSE 1: Title: This article is under embargo with an end date yet to be finalised.
Publisher:	Elsevier
ISSN:	0890-5096
Date of Acceptance:	1 April 2025
Last Modified:	29 Apr 2025 10:45
URI:	https://orca.cardiff.ac.uk/id/eprint/177959

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