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Home > Vascular Annual Meeting > barila_duplex_criteria_determination

Duplex Criteria for Determination of Significant In-stent Stenosis After Angioplasty and Stenting of the Superficial Femoral Artery

Donald T. Baril, Robert Y. Rhee, Justine Kim, Michel S. Makaroun, Rabih A. Chaer, Steven A. Leers, Luke K. Marone.
University of Pittsburgh, Pittsburgh, Pa.

OBJECTIVES: Endovascular intervention is now considered first-line therapy for superficial femoral artery (SFA) occlusive disease. At present, duplex ultrasound criteria for SFA in-stent stenosis and correlation with angiographic data remain poorly defined. The purpose of this study was to develop SFA-specific duplex ultrasound criteria for assessment of in-stent stenosis in the SFA.

METHODS: From May 2003 to Dec 2007, 280 limbs underwent SFA angioplasty and stenting and were followed by serial duplex imaging. Suspected stenotic lesions underwent angiography and intervention when appropriate. Data pairs of duplex and angiographically estimated stenosis within 30 days of each others were analyzed. Fifty-two limbs met the above criteria, including 45 which underwent reintervention. In-stent peak systolic velocity (PSV), the ratio of the stented SFA velocity/proximal SFA velocity, changes in ankle-brachial indices, and percentage of angiographic stenosis were examined. Linear regression and receiver operator characteristic (ROC) curve analyses were used to compare angiographic stenosis with PSV and velocity ratios to establish optimal criteria for determining significant in-stent stenosis.

RESULTS: Mean follow-up for this cohort was 16.9±8.5 months. Of the 45 limbs that underwent reintervention, 27 (60%) were symptomatic while 18 (40%) underwent reintervention based on their duplex ultrasound findings alone. Based on linear regression analyses, the following ranges of in-stent stenosis correlated with the associated PSVs (R2=0.45, p<0.001) and ratios (R2=0.36, p<0.001): 50-69% PSV≥230 cm/s, ratio ≥1.36; 70-79% PSV≥430 cm/s, ratio 3.18; ≥80% PSV≥530 cm/s, ratio ≥4.09. Based on the ROC curves, an 80% in-stent stenosis on angiography correlated with a PSV of 200 cm/s (97% sensitivity, 60% specificity) and a stented SFA/proximal SFA ratio of 3.75 (57% sensitivity, 96% specificity). A significant drop in ABI (>0.15) correlated to a >80% in-stent stenosis, although this trend failed to reach statistical significance (p=.06).

CONCLUSIONS: Based on our study, both PSV and velocity ratio appear to have a significant role in predicting in-stent stenosis. To determine ≥80% stenosis, combining PSV≥200 cm/s and stented SFA/proximal SFA ratio ≥3.75 appears to be optimal.

AUTHOR DISCLOSURES: D.T. Baril, None; R.Y. Rhee, None; J. Kim, None; M.S. Makaroun, None; R.A. Chaer, None; S.A. Leers, None; L.K. Marone, Cordis.