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Surveillance for recurrent stenosis after endovascular procedures. A prospective study
B V Miller1, W J Sharp, A R Shamma
1Department of Surgery, University of Iowa College of Medicine, Iowa City.
Insights
Endovascular procedures for peripheral artery disease show an 89.8% immediate success rate but a high 9-month restenosis rate of 45.4%, suggesting caution in widespread adoption.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Peripheral artery disease (PAD) affects aortoiliac and infrainguinal arteries.
- Endovascular interventions are increasingly used for PAD treatment.
Purpose of the Study:
- To evaluate the early outcomes and restenosis rates of endovascular procedures for PAD.
- To assess the efficacy of various endovascular techniques in treating PAD.
Main Methods:
- Prospective study of 89 endovascular procedures over 1 year.
- Techniques included balloon angioplasty, laser-assisted balloon angioplasty, and atherectomy.
- Preoperative and postoperative surveillance included clinical evaluation, pressure measurements, and duplex ultrasonography.
Main Results:
- Indications included claudication (65.2%), critical ischemia (30.3%), and failing bypass (4.5%).
- Immediate technical success rate was 89.8%.
- Nine-month patency rate was 45.4%, indicating significant restenosis.
Conclusions:
- Endovascular procedures for PAD achieve high initial success but are associated with substantial restenosis rates.
- Further critical studies are needed before widespread acceptance of these techniques.
Abstract:
Eighty-nine endovascular procedures were performed during a 1-year period. Techniques included balloon angioplasty (n = 50), laser-assisted balloon angioplasty (n = 32), and atherectomy (n = 7). Indications were claudication (65.2%), critical ischemia (30.3%), and failing bypass (4.5%). Preoperative evaluation included a history and physical examination, segmental limb pressures, and color duplex ultrasonography. Postoperative surveillance consisted of a history and physical examination, ankle-arm indexes, and color duplex examinations at 1-week, 1-month, and then 3-month intervals. All levels of aortoiliac and infrainguinal disease were treated. Immediate technical success rate was 89.8%. Recurrence rates by life-table analysis reveal a 9-month patency rate of 45.4%. Early results of this prospective study indicate that endovascular procedures are subject to significant restenosis rates. Restraint is advised concerning general acceptance of endovascular procedures pending critical study.