Arterielles Thoracic Outlet Syndrome: Die Bedeutung der Farbkodierten Duplexsonografie in der vaskulären Diagnostik
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Philipps-Universität Marburg
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Abstract
The main objective of this study was to test the validity of color-coded duplex sonography in the diagnosis of arterial thoracic outlet syndrome. Digital subtraction angiography was chosen as the reference method. Secondary objectives were to test the dependence of TOS diagnosis on examiner's experience and a possible added value of color-coded duplex sonography compared to digital subtraction angiography.
51 patients with a mean age of about 40 years and suspected thoracic outlet syndrome were included. In addition to the digital subtraction angiography, all patients underwent a structured color-coded duplex sonography protocol of the upper extremity by two investigators with different levels of experience.
Concordance analysis of the two examination methods mentioned above did not yield any significant difference, so that no statement could be made about a superiority of one method or a possible balance of both methods. A subsequent analysis revealed an insufficient reliability of digital subtraction angiography and thus considerable doubts about its function as a gold standard. Assuming the absence of a true reference method, latent class analysis was chosen as the statistical method and a model with three latent classes emerged. The most frequent diagnosis was confirmation by both methods and the second most frequent was a conservative diagnosis by color-coded duplex sonography as opposed to digital subtraction angiography. There was a high concordance with the discharge diagnosis after completion of all diagnostic procedures. At the same time no surgical indication of vascular thoracic outlet syndrome was missed. Thus, color-coded duplex sonography appears to be more differentiated and of higher value.
Furthermore, there was a high concordance of the findings which were obtained by the experienced and the less experienced examiner with a short training period. Thus, color-coded duplex sonography with an examination protocol specially designed for the clinical picture appears to be an easy-to-learn and easy-to-apply method that provides more valid results.
Even with the apparently low number of 51 patients, color-coded duplex sonography provided additional and relevant information in two patients which could not be obtained by digital subtraction angiography and finally led to an urgent indication for surgery.
Color-coded duplex sonography appears to be the more differentiated method in the vascular diagnosis of thoracic outlet syndrome and is suitable as a screening method due to its many known advantages (noninvasive, inexpensive, widely available, repeatable, dynamic) and the rapid learnability of a simple examination protocol.
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Dates
Created: 2022Issued: 2022-07-04Updated: 2022-07-04
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
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DoctoralThesis
Keywords
AnlernenUntersucherabhängigkeitValidität der Farbkodierten Duplexsonografie in der vaskulären Diagnostik des arteriellem Thoracic Outlet Syndrome
DFG-subjects
Thoracic Outlet SyndromeDigitale SubtraktionsangiografieUntersuchererfahrungUntersucherabhängigkeitFarbkodierte Duplexsonografie
DDC-Numbers
610
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Larbig, Jana-Karolin: Arterielles Thoracic Outlet Syndrome: Die Bedeutung der Farbkodierten Duplexsonografie in der vaskulären Diagnostik. : Philipps-Universität Marburg 2022-07-04. DOI: https://doi.org/10.17192/z2022.0276.
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This item has been published with the following license: In Copyright