Purpose
Conventional angiography is often used in the preoperative work-up of hand surgery
patients with systemic sclerosis. The goal of this study was to propose a classification
system based on the pattern of arterial involvement in a series of upper extremity
angiograms. The authors hypothesized that this classification system would demonstrate
high inter- and intrarater reliability.
Methods
A retrospective review of 110 upper extremity angiograms in patients with systemic
sclerosis (obtained between 1996 and 2017) was performed. Images were classified into
4 types based on the patency of the radial and ulnar arteries at the wrist, and into
3 subtypes based on the patency of the superficial and deep palmar arches. Classification
reliability was compared with Fleiss’ Kappa (for inter-rater) and Cohen’s (for intrarater)
coefficient between 4 fellowship-trained hand surgeons and a hand fellow.
Results
The inter-rater reliability between all 5 observers using types alone was 0.83 (0.80–0.85),
whereas the inter-rater reliability using subtypes was 0.64 (confidence interval [CI]
95%, 0.62–0.65). The intrarater reliability using types alone ranged from 0.80 to
0.95, whereas intrarater reliabilities using subtypes were 0.81 (CI 95%, 0.72–0.90),
0.78 (CI 95%, 0.69–0.87), 0.87 (CI 95%, 0.80–0.95), 0.64 (CI 95%, 0.53–0.75), and
0.92 (CI 95%, 0.86–0.98) for the 4 attendings and a hand fellow, respectively. Fifty-seven
percent of angiograms were interpreted as having loss of ulnar artery patency at the
wrist (type 2) with 77% having additional loss of superficial palmar arch patency
(type 2A).
Conclusions
This large series of angiograms in patients with systemic sclerosis demonstrates a
classification system for conventional angiography that shows high inter-rater and
intrarater reliability using type alone. When subtypes were used, the inter-rater
and intrarater reliabilities decreased to moderate and moderate-to-high, respectively.
Clinical relevance
This study represents the first step in establishing a classification system that,
by grouping patients with similar angiogram findings, may allow for targeted research
into risk stratification, monitoring, and treatment in systemic sclerosis.
Key words
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Article info
Publication history
Published online: February 20, 2019
Accepted:
January 4,
2019
Received:
April 2,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
