Document Detail

Early duplex scanning after infrainguinal endovascular therapy.
MedLine Citation:
PMID:  20974524     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Duplex ultrasound scanning (DUS) has benefit for intraoperative and subsequent evaluation of surgical bypasses in the lower extremities. The utility of DUS after endovascular revascularizations is not established. This study was performed to evaluate whether DUS findings after infrainguinal endovascular interventions for critical limb ischemia (CLI) were predictive of need for reintervention or amputation.
METHODS: To identify the study cohort, peripheral interventions for CLI (Rutherford grades 4, 5, 6) over a 24-month period (2006-2007) were reviewed. DUS findings were considered indicative of hemodynamic stenosis if the peak systolic velocity (PSV) was ≥ 180 cm/s or the PSV velocity ratio was ≥ 2.0. Demographic, clinical, procedural, and outcomes were examined. SVS and TASC II classifications and reporting standards were used. Arteriograms were reviewed and treated segments were categorized as patent (<30% residual stenosis) or abnormal (≥ 30% residual stenosis).
RESULTS: There were 122 infrainguinal interventions for CLI in 113 patients (53% male; mean age 71 years). Risk factors included diabetes: 61%; renal failure: 20%; and smoking (within 1 year): 40%. DUS was performed within 30 days of the index procedure in 90 cases. Fifty patients had an abnormal early duplex and 40 patients had a normal duplex. In patients with a normal duplex ultrasound the amputation rate was 5% vs 20% in the group with an abnormal duplex (P = .04). Primary patency was 56% in the normal duplex group and 46% in the abnormal duplex group (P = .18). Early duplex ultrasound was able to identify a residual stenosis not seen on completion angiography in 56% of cases.
CONCLUSIONS: Duplex scanning detects residual stenosis missed with conventional angiography after infrainguinal interventions. An abnormal DUS in the first 30 days after an intervention is associated with an increased risk of amputation. This suggests a possible role for intraprocedural DUS, as well as routine postprocedure DUS, close clinical follow-up, and consideration of reintervention for residual abnormalities in patients treated for CLI.
Misty D Humphries; William C Pevec; John R Laird; Khung Keong Yeo; Nasim Hedayati; David L Dawson
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Publication Detail:
Type:  Journal Article     Date:  2010-10-25
Journal Detail:
Title:  Journal of vascular surgery     Volume:  53     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-31     Completed Date:  2011-03-10     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  353-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
University of California Davis Medical Center, Sacramento, CA 95817, USA.
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MeSH Terms
Aged, 80 and over
Arterial Occlusive Diseases / physiopathology,  therapy*,  ultrasonography*
Constriction, Pathologic
Critical Illness
Endovascular Procedures* / adverse effects,  instrumentation
Ischemia / physiopathology,  therapy*,  ultrasonography*
Kaplan-Meier Estimate
Lower Extremity / blood supply*
Middle Aged
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex*
Vascular Patency

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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