Duplex-guided percutaneous transluminal balloon angioplasty of superficial femoral artery

Abstract EN

The standard technique of balloon angioplasty of superficial femoral artery requires contrast arteriography and fluoroscopy.

We attempted to perform this procedure with duplex guidance to avoid the use of nephrotoxic contrast material and eliminate radiation exposure.

Materials and Methods: From October 2009 to December 2011, 48 patients (64.6% male) with a mean age of 68 ± 8 years (range, 55-92 years) underwent balloon angioplasty of short (≤4 cm in length), easily visualized superficial femoral artery stenotic/occluded lesions under duplex guidance.

Diabetes, smoking, hypertension, renal insufficiency (serum creatinine level ≥1.5 mg/dl), and hyperlipidemia were present in 33.3%, 66.7%, 41.7%, 54.2%, and 62.5% of patients, respectively.

Disabling claudication was the indication for the procedure in 68.8% of cases, and critical limb ischemia was the indication in 31.2%.

Based on color-coded duplex examination, patients were assigned into two groups.

Group I included 30 cases (62.5%) with arterial stenoses, whereas Group II included 18 cases (37.5%) with arterial occlusions.

The ipsilateral common femoral artery was cannulated under direct duplex visualization.

Still under duplex guidance, a guidewire was directed into the superficial femoral artery, across the diseased segment, and parked at the tibioperoneal trunk.

The diseased segment was then balloon-dilated.

Balloon diameter and length were chosen according to arterial measurements obtained by duplex scan.

Hemodynamically significant defects causing diameter reductions greater than 30% and peak systolic velocity ratios greater than 2 were stented with self-expandable stents under duplex guidance.

Completion duplex examinations and ankle brachial indices were obtained routinely before hospital discharge.

Results: Whereas, the overall technical success rate was 95.8% (46/48 cases), it was 100% (30/30 cases) in Group I, and 88.9% (16/18 cases) in Group II.

There was no statistically significant difference in technical success between the two groups (P value = 0.1).

Hemodynamically significant residual defects that required stenting were documented in 6 (13%) of the 46 successfully cannulated cases.

There was no statistically significant difference regarding the need for stenting between the two groups (P value = 1).

After successful DGBA, the PSV (in 30 patients) decreased significantly from a mean of 419 ± 27 cm/sec to 111 ± 20 cm/sec (P value <0.0001), and the PSV ratio decreased significantly from a mean of 7.4 ± 1.2 to 1.2 ± 0.2 (P value <0.0001).

On the other hand, the ABI (in 46 patients) increased significantly from a mean of 0.5 ± 0.1 to 0.9 ± 0.1 (P value <0.0001).

The overall 6-month survival and limb salvage rates were 100%.

The overall 6-month patency rate was 91.3% (42/46 cases).

There was no statistically significant difference regarding the patency rate between the two groups (P value = 0.1).

Conclusions: Duplex-guided balloon angioplasty and stent placement is a safe, effective alternative to the standard fluoroscopy guidance for the treatment of short, adequately visualized SFA stenotic/occluded lesions.

It offers multiple advantages, including guidance of the arterial access, precise selection of the balloons and stents, and confirmation of the adequacy of the technique by reliable hemodynamic and imaging parameters.