Duplex-guided percutaneous transluminal angioplasty in iliac arterial occlusive disease
A G Krasznai1, T A Sigterman, R J Welten
1Department of Surgery, Division of Vascular Surgery, Atrium Medical Centre, Heerlen, The Netherlands.
Insights
Duplex-guided angioplasty for iliac artery stenosis is safe and effective. This technique avoids contrast dye, offering a crucial benefit for patients with chronic renal insufficiency.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Chronic renal insufficiency (CRI) is a significant global health concern.
- Percutaneous transluminal angioplasty (PTA) can be performed without nephrotoxic contrast agents using Doppler-ultrasound (Duplex) guidance.
- While Duplex-guided infra-inguinal interventions are established, Duplex-guided iliac interventions are less common due to anatomical challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in treating iliac artery lesions.
- To assess the feasibility of performing iliac interventions without traditional contrast agents.
Main Methods:
- Thirty-one patients (35 iliac lesions) with indications from Rutherford 3 to 5 underwent DuPTA between June 2012 and February 2013.
- Preoperative assessments included Ankle Brachial Index (ABI), Duplex ultrasound, and Magnetic Resonance Angiography (MRA).
- Procedural success was defined as successful guidewire crossing and lesion dilation/stenting; clinical success was defined as a 50% reduction in peak systolic velocity (PSV) or clinical improvement.
Main Results:
- Procedural success was achieved in 94% of patients (33/35), with all successful procedures also demonstrating clinical success.
- Post-procedural PSV showed a significant average improvement of 63% (from 431 cm/s to 153 cm/s).
- Mean preoperative ABI improved from 0.72 to 0.88 postoperatively.
Conclusions:
- Duplex-guided PTA is a safe and effective method for treating significant iliac artery stenosis.
- This technique offers substantial advantages for patients at high risk of contrast-induced nephropathy.
- DuPTA represents a viable alternative to conventional angiography for iliac interventions in select patient populations.
Background:
Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance. Duplex-guided infra-inguinal interventions and access-related interventions have been reported. Duplex-guided iliac interventions have not been performed to any extent because of the anatomic location. In our study we evaluated the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in iliac arteries.
Methods:
From June 2012 until February 2013, 31 patients (35 iliac lesions), underwent DuPTA. Indications ranged from Rutherford 3 to 5. Preoperative evaluation included Ankle Brachial Index (ABI), Duplex and MRA. Procedural success was defined as crossing the lesion with a guidewire and dilating or stenting the lesion. Clinical success was defined as 50% reduction in peak systolic velocity (PSV) or clinical improvement. PSV was evaluated after PTA, then at 2 weeks. Clinical results were assessed 2 weeks after the procedure.
Results:
Procedural success was achieved in 94% of patients (33/35), all of whom also had clinical success. Post-procedural PSV reduction showed an average improvement of 63% (431 cm/s to 153 cm/s). Mean preoperative ABI was 0.72 and improved to 0.88 postoperatively.
Conclusions:
PTA using Duplex-guidance in significant iliac stenosis is a safe method with major advantages in patients at high risk for developing contrast-induced nephropathy.
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