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Home > Vascular Annual Meeting > RR35. Is There a Role for Duplex Ultrasound Surveillance...

RR35. Is There a Role for Duplex Ultrasound Surveillance After Endovascular Therapy for Infrainguinal Arterial Disease?

Gautam V. Shrikhande, Rajeev Dayal, Ashley Graham, Habib Khan, Combiz Rezayat, James F. McKinsey
Cornell/Columbia, New York, NY

OBJECTIVES: Studies of duplex surveillance of lower extremity bypass grafts have led to the use of velocity ratios of 2.0-2.5 as an indication for bypass graft intervention. The goal of this study is to determine the utility of duplex scanning to detect angiographic restenosis following endovascular therapy in patients with infrainguinal arterial disease.

METHODS: A prospective registry with all patients treated for lower extremity atherosclerotic disease from May 2004 to September 2008 was established. Patients were followed with duplex ultrasound at 1, 3, 6, and 12 months and annually. Patients receiving repeat angiograms were identified and angiogram and duplex data abstracted. Linear regression analysis was used.

RESULTS: 1709 infrainguinal arterial lesions in 713 patients were treated. Repeat angiograms were performed on 345 lesions in 143 patients. Indications for the initial intervention were claudication (n=62, 43.4%), rest pain (n=23, 16.1%), and tissue loss (n=58, 40.5%). 172 SFA lesions, 62 popliteal lesions, and 20 tibial lesions were identified by surveillance duplex in 103 patients. 65% of the patients were diabetic. Mean follow up was 7.5 (0.6-14.4) months. PSV versus degree of angiographic stenosis showed strong correlation coefficients for superficial femoral artery disease (R2 =0.61) and for popliteal disease (R2 =0.71). Poor correlation was found in patients who were found to have tibial disease (R2 =0.003). For chronic total occlusions, 49 of 56 lesions (87.5%) found to be occluded by duplex surveillance were occluded by angiography. When analyzing the lesions based on velocity ratios of <2.0, 24 of 96 (25%) had >70% angiographic stenosis. In lesions with ratios from 2.0-2.5, 12 of 13 (92.3%) had >70% angiographic stenosis and in lesions with ratios >2.5, 75 of 77 (97.4%) had >70% angiographic stenosis.

CONCLUSIONS: Duplex ultrasound surveillance after endovascular intervention for infrainguinal arterial disease correlates to the degree of angiographic stenosis based on PSV in the SFA and popliteal region. Correlation in the tibial vessels is poor. Further, duplex is valuable for determining occlusions. Velocity ratios >2.0 appear to correlate to angiographic stenosis of >70%. Duplex ultrasound surveillance appears to have a role in guiding therapy after endovascular interventions.

AUTHOR DISCLOSURES: G.V. Shrikhande, None; R. Dayal, None; A. Graham, None; H. Khan, None; C. Rezayat, None; J.F. McKinsey, None.