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The value of duplex surveillance after endovascular intervention for femoropopliteal obstructive disease
A V Tielbeek1, E Rietjens, J Buth
1Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
Insights
Clinical assessment, including ankle blood pressure, is more effective than Duplex ultrasound for monitoring endovascular interventions in femoropopliteal arteries. This approach better identifies impending treatment failures post-procedure.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Endovascular interventions are common for femoropopliteal artery disease.
- Monitoring for treatment failure after these procedures is crucial for patient outcomes.
- Duplex ultrasound and clinical assessment are used for follow-up.
Purpose of the Study:
- To prospectively evaluate the utility of serial Duplex examinations in detecting impending failure after endovascular femoropopliteal interventions.
- To compare the effectiveness of Duplex surveillance versus clinical/hemodynamic assessment in identifying treatment failure.
Main Methods:
- Prospective study of 124 patients undergoing endovascular femoropopliteal procedures.
- Follow-up included color-flow Duplex examinations and clinical assessments with ankle blood pressure measurements.
- Impending failure criteria: Duplex peak systolic velocity ratio > 2.5; clinical/hemodynamic level < +2.
Main Results:
- Duplex abnormalities were found in 52 patients, predicting failure with 86% sensitivity and 75% specificity.
- Clinical/hemodynamic assessment showed higher predictive accuracy with 93% sensitivity and 90% specificity.
- Hypothetical analysis suggested Duplex surveillance alone would have led to only one reintervention for restenosis.
Conclusions:
- Clinical/hemododynamic assessment is superior to Duplex surveillance for post-endovascular intervention follow-up.
- Routine Duplex monitoring may not be the most effective strategy for identifying impending femoropopliteal intervention failure.
Objective:
The objective of the present study was to assess prospectively whether serial Duplex examination was useful in identifying impending failure after endovascular interventions of the femoropopliteal arteries.
Setting:
Non-university hospital. Prospective clinical study.
Methods:
124 Patients were successfully treated by endovascular procedures during a 5 year period. The follow-up was by colour-flow Duplex examination at fixed intervals. At similar intervals clinical examination, including ankle blood pressure measurement was performed to assess the clinical/haemodynamic status of the patients according to the SVS/NAISCVS guidelines. For the diagnosis of impending failure the Duplex criterion was a peak systolic velocity ratio > 2.5 and the clinical/haemodynamic criterion was a level < +2. Actual failure of the vascular procedure was defined as the occurrence of an occlusion in the treated arterial segment or a recurrent stenosis causing symptoms severe enough to require a reintervention. No prophylactic reinterventions were performed on the basis of abnormal Duplex findings alone.
Results:
Abnormal Duplex findings indicating restenosis were observed in 52 patients. Duplex abnormalities predicted treatment failure with a sensitivity of 86% and a specificity of 75%, while clinical/haemodynamic assessment had a sensitivity of 93% and a specificity of 90%. The hypothetical management outcome if Duplex surveillance had been used as a basis for reintervention was assessed. It appeared that only one patient with failure would have received a redo endovascular procedure at the time he had a restenosis.
Conclusions:
Clinical/haemodynamic assessment was more useful for the follow-up of endovascular interventions than Duplex surveillance.
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