Retrospective study of rapid-exchange monorail versus over-the-wire technique for femoropopliteal angioplasty.
OBJECTIVE
The purpose of this study was to compare procedural outcome of rapid-exchange (RX) monorail versus conventional over-the-wire (OTW) technique for femoropopliteal angioplasty.


METHODS
Demographic data, procedure details, angioplasty success, and complications of 328 consecutive percutaneous transluminal angioplasties (PTAs) were collected from a prospective database and retrospectively analyzed. Procedure details included duration of fluoroscopy, area-dose product, amount of contrast agent, sheath sizes, access route, length of stenosis, presence of total occlusion, technical and anatomical success (residual stenosis < 30% in the absence of complications), need for bail-out stenting, and periprocedural complications. The RX technique alone was used in 102 of 328 cases (31%); the OTW technique, in 226 of 328 of cases (68%).


RESULTS
Technical success was 98% for the RX versus 95.4% for the OTW technique (p = 0.2). A significantly greater number of stents had to be implanted due to angioplasty failure when the OTW technique was used (RX, 5.9%; OTW, 13.7%; p = 0.04). There were no significant differences in fluoroscopy time, dose-area product, or amount of contrast medium used. The RX system facilitated the use of smaller sheath sizes (5 Fr = 38% and 6 Fr = 59% for RX versus 5 Fr = 16.8% and > or = 6 Fr = 82.5% for OTW) but showed only a tendency toward lower overall complication rates (16.6% [17/102] in the RX group versus 19.9% [45/226] in the OTW group; p = 0.09). There was no effect on length of hospitalization. RX monorail systems were not associated with higher procedural costs when compared to conventional OTW technique.


CONCLUSIONS
We conclude that RX monorail systems seem to enhance the technical success of femoropopliteal angioplasty. Although smaller sheath sizes can be used due to the lower profile of the RX systems, there is only a tendency toward lower complication rates.
Jahnke
Thomas
T
Klinik für Diagnostische Radiologie, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. jahnke@prontomail.com
Schäfer
Jost Philipp
JP
Bolte
Hendrik
H
Schäfer
Fritz
F
Michalek
Jens
J
Charalambous
Nicholas
N
Sapoval
Marc
M
Müller-Hülsbeck
Stefan
S
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011336:Probability; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome