Ultrasound Can Guide Femoral Artery Angioplasty

BY JEFF EVANS

LONDON -- Duplex ultrasound is becoming a safe and accurate alternative intraoperative imaging modality for guiding balloon angioplasty procedures in patients with stenoses or occlusions in the femoral popliteal segment, Dr. Enrico Ascher said at the Charing Cross 28th International Symposium.

In the department of vascular surgery at the Maimonides Medical Center, New York, Dr. Ascher and his colleagues have adopted duplex ultrasound for use during angioplasty procedures because of the center's experience with duplex arterial mapping for bypass surgery. About 89% of the center's bypasses were performed on the basis of duplex ultrasound scans alone, without preoperative arteriograms, Dr. Ascher said.

ULTRASOUND-GUIDED ANGIOPLASTY VISUALIZES THE ENTIRE VESSEL, NOT JUST THE LUMEN, AND CAN CONFIRM PATENCY WITH IMAGING AND HEMODYNAMIC PARAMETERS.

Duplex-guided balloon angioplasty uses no radiation or nephrotoxic contrast agent (unlike CT arteriography) and can provide a multiplanar approach with magnification. Duplex-guided angioplasty also allows one to visualize the entire blood vessel--not just its lumen--and to confirm patency with both imaging and hemodynamic parameters, said Dr. Ascher, director of the Vascular Institute of New York at the medical center.

Even under a lead apron, a surgeon's total effective dose of radiation during fluoroscopically guided procedures is not trivial, even though such doses are less than the limit imposed by the International Commission on Radiological Protection, he said. In a study of 47 cases of endovascular aneurysm repair, three vascular surgeons over the course of a year received about 1-1.6 mSv under a lead apron and 5-19 mSv per year on exposed hands (J. Vasc. Surg. 2000;32:704-10).

Some of the fluoroscopically guided superficial femoral artery angioplasty cases can have comparable radiation exposures.

Of 398 cases of balloon angioplasty--most guided by duplex ultrasound--that were performed by Dr. Ascher and his colleagues during 2003-2006, 330 involved stenosis or occlusion of the femoral popliteal segment in 255 patients. These 330 cases involved 210 single or multiple stenoses and 120 occlusions.

About 75% of the lesions were classified as TransAtlantic Inter-Society Consensus type C or D. Most of the patients had claudication (62%) rather than critical limb ischemia (38%). Many of the patients were diabetic (52%) or had elevated creatinine levels (37%).

Dr. Ascher and his associates achieved technical success in 94% of the cases. The procedure failed in only one case with stenosis and in 18 cases with occlusion. Stents were placed in 64% of the cases.

At 30 days after the procedure, 96% of the patients had clinical improvement in blood flow or symptoms. Only one patient died, Dr. Ascher said.