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Mistydawn Humphries, William C. Pevec, John R. Laird, Jr., Khung K. Yeo, Nasim Hedayati, David L. Dawson
University of California, Davis, Sacramento, CA
OBJECTIVES: Duplex ultrasound scanning (DUS) has benefit for evaluation of surgical bypasses in the lower extremities. The utility of DUS with endovascular revascularizations is not established. This study was performed to evaluate whether DUS findings after infra-inguinal endovascular interventions for critical limb ischemia (CLI) were predictive of need for early reintervention or patients’ amputation-free survival.
METHODS: To identify the study cohort, peripheral interventions for CLI (Rutherford grades 4,5,6) over a 24 month period (2006-2007) were reviewed. DUS findings were considered abnormal if the peak systolic velocity (PSV) was ≥180 cm/s or the PSV velocity ratio was ≥2.0. Demographic, clinical, procedural, and outcomes were examined. SVS and TASC II classifications and reporting standards were used. Arteriograms were reviewed and treated segments were categorized as patent (<30% residual stenosis) or abnormal (≥30% residual stenosis).
RESULTS: There were 144 infra-inguinal interventions for CLI in 114 patients (52% male; mean age 68.8 years); 123 limbs were treated. Treated segments were TASC II C or D, or had severe infra-popliteal disease in 68%. Risk factors included diabetes: 25%; renal failure: 11%; smoking (within 1 year): 23%.Mortality at 12 months was 16.7%; with a preceding major amputation in 4 of 19. DUS was performed within 30 days of the index procedure in 90 cases. A normal DUS finding was associated with better limb salvage (p=0.06). Abnormal early DUS findings were noted after 26 CLI interventions that had no demonstrated residual abnormality with completion angiography (47%).
CONCLUSIONS: DUS detects residual stenoses missed with angiography after CLI interventions. An abnormal DUS within 30 days after an intervention was associated with increased risk of treatment failure (need for secondary procedures, limb loss). This suggests a role for intra-procedural DUS, as well as routine post-procedure DUS, close clinical follow up, and consideration of re-intervention for residual abnormalities.
AUTHOR DISCLOSURES: M. Humphries, None; W.C. Pevec, None; J.R. Laird, None; K.K. Yeo, None; N. Hedayati, None; D.L. Dawson, None.
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