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Duplex controlled angioplasty
G Ramaswami1, A al-Kutoubi, A N Nicolaides
1Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical Unit, St. Mary's Hospital, London, U.K.
Insights
Duplex ultrasound imaging enabled successful angioplasty for peripheral artery lesions, reducing the need for X-ray exposure. This technique allows real-time monitoring of both artery anatomy and blood flow during the procedure.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Interventional Cardiology
Background:
- Peripheral artery disease (PAD) often requires interventions like angioplasty.
- Accurate lesion assessment and procedural guidance are crucial for successful angioplasty.
- Minimizing radiation exposure during interventional procedures is a significant clinical goal.
Purpose of the Study:
- To evaluate the feasibility and efficacy of using Duplex ultrasound for guiding angioplasty of peripheral arterial lesions.
- To assess the ability of a novel catheter system with integrated Duplex transducer to monitor angioplasty in real-time.
- To determine the extent to which Duplex control can replace or reduce the need for conventional angiography and fluoroscopy.
Main Methods:
- Duplex ultrasound examination was used to identify and assess 38 peripheral arterial lesions (31 stenoses, 7 occlusions) in 16 patients with claudication.
- A specialized catheter with an integrated piezoelectric transducer at the balloon's center was employed for angioplasty.
- The Duplex system provided real-time visualization of the balloon's position, guide wire, and allowed for pre-, intra-, and post-procedural hemodynamic assessment.
Main Results:
- Thirteen lesions (seven superficial femoral artery, three external iliac, two common iliac, one graft) were treated with Duplex-controlled angioplasty.
- In 11 out of 13 lesions (85%), angioplasty was performed entirely under Duplex control, with only two cases requiring additional X-ray guidance.
- Duplex ultrasound facilitated accurate balloon sizing and visualization of the guide wire, enabling direct ultrasound-guided puncture in one case.
Conclusions:
- Duplex ultrasound is a valuable tool for monitoring both anatomical and hemodynamic parameters during peripheral angioplasty.
- The use of Duplex guidance can significantly reduce reliance on ionizing radiation (X-ray).
- Initial experience suggests that angioplasty can be effectively performed in the majority of suitable lesions using Duplex control alone.
Abstract:
Duplex examination was carried out to assess lesions in peripheral arteries amenable to angioplasty. With the help of a special catheter, angioplasty of these lesions was performed under Duplex control. Sixteen patients presenting with claudication were examined by Duplex and 38 lesions were identified (31 stenoses, seven occlusions) and all the findings except one (vessel E1) were confirmed by subsequent angiography. Sixteen lesions were considered amenable to angioplasty and 13 lesions (in 10 patients) were selected for Duplex controlled angioplasty. A new catheter system which has a piezo-electric transducer at the centre of the balloon and integrated to a Duplex scanner via a catheter system interface, was used for the procedure. This allows the exact position of the balloon to be represented on the screen. Thirteen lesions (seven superficial femoral artery (SFA), three external iliac, two common iliac and one graft) were subjected to angioplasty under Duplex control. In one patient, the SFA was punctured directly under ultrasound control as the profunda was diseased. The guide wire was visualised in all cases and in the majority of cases, balloon size for the angioplasty was chosen by measurement of the arterial diameter by Duplex, which was also used for haemodynamic evaluation before, during and after the procedure. Eleven lesions (85%) underwent angioplasty entirely under Duplex control and additional X-ray control was needed in only two cases. In conclusion, Duplex allows the monitoring of both anatomical and haemodynamic parameters during angioplasty. It also reduces the risk of ionising radiation. Our initial experience has been encouraging as angioplasty was performed in the majority of lesions purely under Duplex control.