Lower extremity revascularization without contrast arteriography: a prospective study of operation based upon duplex...

This study prospectively assessed the results of lower extremity surgical revascularization, which was performed on the basis of duplex arterial mapping in selected patients without preoperative contrast arteriography. Criteria were developed for patient selection. Among 158 patients requiring surgery for lower extremity ischemia over a 24-month period, 24 (15%) were selected for operation without current preoperative arteriography. Aorto-iliac and infrainguinal duplex arterial mapping were performed in an laboratory that was accredited by the Intersocietal Commission for Accreditation of Vascular Laboratories. Indications for surgery were minor gangrene (11), rest pain (7), or claudication (6). Operations included femoropopliteal bypass (14), femoral endarterectomy (9) and femoral-femoral bypass (1). Mean length of stay was 4.5 +/- 2.0 days. Ankle-brachial index improved from 0.49 +/- 0.12 to 0.80 +/- 0.15 (P < 0.05). Primary patency was 91.7 +/- 9.4% and assisted primary patency was 100% at 18 months. There was no graft occlusion or limb loss. Mean follow-up was 16.7 +/- 7.0 months. These preliminary data support the safety and durability of duplex-guided lower extremity surgical revascularization without arteriography in selected cases. Success in a broader application of this approach requires the continuing development of patient selection criteria.