The value of duplex surveillance after endovascular intervention for femoropopliteal obstructive disease.
OBJECTIVE
The objective of the present study was to assess prospectively whether serial Duplex examination was useful in identifying impending failure after endovascular interventions of the femoropopliteal arteries.


METHODS
Non-university hospital. Prospective clinical study.


METHODS
124 Patients were successfully treated by endovascular procedures during a 5 year period. The follow-up was by colour-flow Duplex examination at fixed intervals. At similar intervals clinical examination, including ankle blood pressure measurement was performed to assess the clinical/haemodynamic status of the patients according to the SVS/NAISCVS guidelines. For the diagnosis of impending failure the Duplex criterion was a peak systolic velocity ratio > 2.5 and the clinical/haemodynamic criterion was a level < +2. Actual failure of the vascular procedure was defined as the occurrence of an occlusion in the treated arterial segment or a recurrent stenosis causing symptoms severe enough to require a reintervention. No prophylactic reinterventions were performed on the basis of abnormal Duplex findings alone.


RESULTS
Abnormal Duplex findings indicating restenosis were observed in 52 patients. Duplex abnormalities predicted treatment failure with a sensitivity of 86% and a specificity of 75%, while clinical/haemodynamic assessment had a sensitivity of 93% and a specificity of 90%. The hypothetical management outcome if Duplex surveillance had been used as a basis for reintervention was assessed. It appeared that only one patient with failure would have received a redo endovascular procedure at the time he had a restenosis.


CONCLUSIONS
Clinical/haemodynamic assessment was more useful for the follow-up of endovascular interventions than Duplex surveillance.
Tielbeek
A V
AV
Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
Rietjens
E
E
Buth
J
J
Vroegindeweij
D
D
Schol
F P
FP
D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D017073:Atherectomy; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D013997:Time Factors; D017211:Treatment Failure; D018616:Ultrasonography, Doppler, Duplex