Sherif Sultan2, Wael Tawfick1
1Vascular & Endovascular Surgery, Western Vascular Institute, Galway, Ireland; 2Galway Clinic, Galway, Ireland.
OBJECTIVES: Our endeavor is to appraise DUAM as the exclusive imaging modality when planning for CLI EvR. Primary endpoint is sensitivity and specificity of DUAM, compared to MRA or DSA. Secondary endpoints were procedural, hemodynamic, clinical outcomes, cost-effectiveness and amputation free survival.
METHODS: DUAM was the sole pre-operative mapping modality. MRA was only used where DUAM was inconclusive due to heavy calcification.
From 2002 to 2009, 3,490 patients were referred with peripheral vascular disease. 483patients underwent revascularization for TASC C/D lesions (EvR: n=310; BS: n=173).
RESULTS: DUAM displayed 97% sensitivity and 98% specificity in identifying lesions requiring intervention. MRA was utilized in 62 patients (12.8%) with 82% specificity. DUAM accurately identified the total number of target lesions for revascularization (TLR) however MRA overestimated it. The expenditure of DUAM is lower than both DSA and MRA.
Of 421procedures based on DUAM, immediate clinical improvement was comparable between EvR and bypass surgery (BS), with improvement to Rutherford category 3 or less 98% in EvR and 97% in BS (p=0.71). Six-year freedom from binary re-stenosis was 72.8% EvR and 65.3% BS (p=0.7001, hr=1.10, 95% CI=[-0.69to1.74]). Six-year amputation-free survival was 72.9% EvR and 71.2% BS (p=0.9765, hr=0.95, 95% CI=[-0.60to1.51]).
Comparing procedures performed based on DUAM to those based on MRA, 6-year binary re-stenosis was 69% for DUAM procedures vs. 57% for MRA procedures (p=0.02, hr=0.255, 95% CI=[0.09-0.71]).
CONCLUSIONS: DUAM is an outstanding pre-operative imaging tool and epitomizes a minimally invasive modality to road-map EvR for CLI and offers precise consecutive data with hemodynamic outcome and limb salvage superior to EvR based on MRA. We believe that DUAM is economically proficient, primary modality for managing patients with CLI.
AUTHOR DISCLOSURES: S. Sultan, Nothing to disclose; W. Tawfick, Nothing to disclose.
Posted April 2012