When to Stop Angioplasty in Peripheral Vessels (Arteries)

RATIONALE AND OBJECTIVES: The aim of the study was to assess parameters for immediate decisions to optimize peripheral arterial angioplasties and prognostic factors with the help of a intravascular Doppler guide wire in patients with peripheral arterial occlusive disease. METHODS: Measurements were done prior to and following angioplasty in 22 patients with peripheral arterial occlusive disease as additional therapy (stent insertion and tibial angioplasty) was performed. For stress assessment, adenosine-triphosphate (ATP) was given intra-arterially in the vessel periphery. Decisions to perform peripheral angioplasty or stent insertion were made according to morphologic parameters. Follow-up was performed by angiography, color-coded duplex ultrasound or judged by unequivocal improved clinical stage at follow up to 13 month. RESULTS: All but three patients showed an increase in maximal peak velocity (MPV) following angioplasty from 41.2 +/- 23 cm/sec to 67.7 +/- 26 cm/sec. After application of a vasodilator all flow parameters increased in every patient (mean = 61.0 +/- 23.4 cm/sec to 91.0 +/- 32.0 cm/sec). The most well suited parameter to decide stent insertion was the maximal peak velocity in rest. If extremities required peripheral angioplasty the increased flow following ATP application was a valuable parameter. A ratio of 1.9 was of positive prognostic value. CONCLUSIONS: The Doppler guide wire is a practical and valuable tool in assessing technical success after angioplasty of peripheral lesions, critical or tandem lesions. It is suitable for indication to stent insertion or tibial angioplasty and of prognostic value.