Early duplex scanning after infrainguinal endovascular therapy
Misty D Humphries1, William C Pevec, John R Laird
1University of California Davis Medical Center, Sacramento, CA 95817, USA.
Journal of Vascular Surgery
|October 27, 2010
Summary
Early duplex ultrasound (DUS) after infrainguinal endovascular interventions for critical limb ischemia (CLI) can predict amputation risk. An abnormal DUS within 30 days indicates a higher likelihood of amputation, highlighting DUS’s role in managing CLI patients.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Interventional Cardiology
Background:
- Duplex ultrasound scanning (DUS) is valuable for evaluating surgical bypasses in lower extremities.
- The effectiveness of DUS after endovascular revascularization for critical limb ischemia (CLI) remains unclear.
Purpose of the Study:
- To determine if DUS findings after infrainguinal endovascular interventions for CLI predict the need for reintervention or amputation.
Main Methods:
- Reviewed 122 infrainguinal interventions for CLI (Rutherford grades 4-6) from 2006-2007.
- Defined hemodynamic stenosis by peak systolic velocity (PSV) ≥ 180 cm/s or PSV ratio ≥ 2.0.
- Analyzed demographic, clinical, procedural data, and outcomes, using SVS and TASC II standards.
Main Results:
- In 113 patients, 90 had DUS within 30 days; 50 showed abnormal results.
- Abnormal DUS was linked to a 20% amputation rate versus 5% with normal DUS (P=.04).
- Early DUS identified residual stenosis missed by angiography in 56% of cases.
Conclusions:
- Duplex ultrasound detects residual stenosis missed by conventional angiography post-intervention.
- Abnormal early DUS is associated with increased amputation risk in CLI patients.
- Suggests a role for intraprocedural and postprocedure DUS, close follow-up, and reintervention for residual abnormalities.
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