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Infrainguinal Balloon Angioplasty For Arterial Occlusive Disease: A Comparison Of Duplex-Guided (DG) With Dye-Based Fluoroscopy (DBF) In A Recent Series

Anil Hingorani, Fred Usoh, Enrico Ascher, Natalie Marks, Alessandra Puggioni, Alexander Shiferson, Victor  Tran, Theresa Jacob.
Maimonides Medical Center, Brooklyn, NY.

OBJECTIVES: To compare traditional DBF imaging modality with recently introduced DG technique for femoral-popliteal balloon angioplasty, we reviewed our experience with each method accumulated over the last 27 months with 328 lower extremities.

METHODS: Eighty-four lower extremities(26%)in 84 patients underwent 89 DBF balloon angioplasties, and 244 lower extremities(74%)in 219 patients underwent 291 DG-balloon angioplasties. All cases involved femoral-popliteal arterial segments. Indications for procedures included claudication(57% in DBF group, 67% in DG group)and limb-threatening ischemia(43% in DBF group, 33% in DG group)with p=0.08. Availability of expert RVT was the only criterion for choice of imaging technique.

RESULTS: Both DBF and DG groups were comparable for age, risk factors and extent of disease(TASC).Mean follow-up was 6.6±5.7 month for DBF group and 7±6 month for DG group with P=0.58. Intraoperative thrombo-embolization occurred in 6 cases(6.6%)in DBF group and in 11 cases (3.8%)in DG group (p=0.25). Although none of the patients in DG group had an increase in serum creatinine level following the procedure, 12% of the patients in DBF group had at least 0.5mg/dL increase in serum creatinine following the procedure with p<0.001. Early occlusion(<1 month)was encountered in 7 cases(7.8%)in DBF group and in 12(4.1%) in DG group(p=0.17). Six-month primary patency was 71% for DBF group and 69% for DG group(p=NS). The 30-day limb salvage was 100% in both groups and 30-day survival was98% for DBF group and100% for DG group.

CONCLUSIONS: These data show that similar patency results can be obtained with both techniques. DG is superior in terms of postprocedural renal insufficiency.