The role of duplex scanning versus angiography in predicting outcome after balloon angioplasty in the femoropopliteal artery

Abstract

Duplex-derived velocity measurements were used to assess the hemodynamics of 64 femoropopliteal arterial sites in 59 patients after angiographically successful percutaneous transluminal balloon angioplasty. With use of angiography as the gold standard, percutaneous transluminal balloon angioplasty was judged to be successful if (1) evidence existed of a "split" caused by intimal dissection and splitting of atherosclerotic plaque; and (2) no significant diameter-reducing residual stenosis was observed at the percutaneous transluminal balloon angioplasty site. At 1 month, 55 limbs (86%) were hemodynamically and clinically improved by SVS/ISCVS clinical criteria for chronic limb ischemia. Of the 55 percutaneous transluminal balloon angioplasty sites, duplex scanning had identified 40 (63%) sites with a less than 50% diameter-reducing stenosis and 15 (27%) sites with a greater than 50% diameter-reducing stenosis within a week after percutaneous transluminal balloon angioplasty. Independent review of the 55 angiograms taken after percutaneous transluminal balloon angioplasty identified 39 sites (71%) with a split and 16 sites (29%) without. By life-table analysis, a greater than 50% diameter-reducing stenosis predicted a worse clinical outcome (15% at 1 year) compared with the presence of a less than 50% diameter-reducing stenosis (84% at 1 year) (p less than 0.001; log rank test). The presence or absence of an angiographic split was not a predictive factor of percutaneous transluminal balloon angioplasty outcome (split, 61% at 1 year; no split, 62% at 1 year) (p = 0.832; log rank test). The detection of a functional residual stenosis by duplex scanning did not correlate with angiographic appearance, but was predictive of clinical failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Colour Doppler sonography of limb arteries

“…The authors suggested that duplex Doppler assessment of residual stenosis might be superior to angiography, haemodynamic measurement or clinical assessment for predicting the success of PTA. Patients with an increase of peak systolic velocity at the angioplasty site greater than 100 % had a 15 % 1-year patency rate compared with 84 % patency rate of arterial segments with a peak systolic velocity increase less than 100 % [55]. Spijkerboer et al also reported that a residual duplex stenosis 1 day after PTA was prognostic for failure within 1 year [56].…”

“…Some authors recommend Doppler ultrasonic monitoring during the procedure or early duplex surveillance to detect failures after PTA, especially in femoro-popliteal arteries. Using duplex scanning, Mewissen et al [55] showed that a PTA site with velocity spectra of a greater than 50 % residual stenosis can be masked on completion angiography and was predictive of failure as well as clinical deterioration. The authors suggested that duplex Doppler assessment of residual stenosis might be superior to angiography, haemodynamic measurement or clinical assessment for predicting the success of PTA.…”

“…Similarly, patients with in situ vein grafts may have focal stenosis which is usually amenable to identification with US examination alone; thus, surgical revision performed on the basis of duplex information appears to be safe. Moreover, some reports have demonstrated Doppler sonography to be accurate in predicting the suitability of arterial lesions for endovascular interventions [54,55,57].…”

Management of Patients After Endovascular Interventions for Peripheral Artery Disease

“…46 Others identified ultrasound as a valuable tool in identifying residual percutaneous transluminal angioplasty stenosis and found it to be predictive of future restenosis and occlusion. 47 Ultrasound surveillance after stent implantation, on the other hand, allows identification of moderate-to high-grade restenosis at a stage when reintervention may maintain patency of the stent and prevent its occlusion. Once a stent occludes, the durability of any reintervention is limited.…”

The natural history of duplex-detected stenosis after femoropopliteal endovascular therapy suggests questionable clinical utility of routine duplex surveillance

“…Some investigators have suggested that DUS after EVT has no role, 13,14 whereas others have reported that residual stenosis on the initial DUS is a major risk factor for subsequent EVT failure. 15,16 We routinely enroll patients into a DUS protocol after both open bypass and EVT. Our reintervention criteria for DU-detected lesions after infrainguinal bypass follow established parameters.…”