Short-term Follow-up of Duplex Guided Angioplasty for Femoropopliteal Arterial Occlusive Disease

Aim: The aim of this study is to evaluate initial and short-term result of duplex guided angioplasty (DGA) for treatment of femoropopliteal arterial lesions.

Methods: From October 2017 to September 2020, 50 limbs in 50 patients (30 males) underwent DGA in our institution. The study was conducted on patients suffered from chronic lower limb ischemia of grade IIb, III and IV (according to Fontaine Classifications) resulting from femoropopliteal lesions (occlusion or stenosis). Arterial access was done under duplex guidance followed by advancing a guidewire across the diseased femoropopliteal segment(s). The diseased segment(s) were then balloon-dilated. Intimal dissection or residual stenosis causing diameter reductions greater than 30% were stented with a self-expandable stent under duplex guidance. Completion duplex examinations and ankle brachial indices were obtained after the procedure.

Results: The mean age of patients was 64 ±8 years. Critical ischemia was the indication in 44%, and disabling claudication was the indication in 6% of cases. Technical success was achieved in 46 cases (92%). 31 cases (62%) went through transluminal crossing of the lesions using duplex guidance alone, 11 cases (22%) went transluminally using duplex combined with contrast-free fluoroscopic assistance and 4 cases (8%) was subjected to subintimal angioplasty using combined techniques. Stenting was done in 24 cases (48%), 16 cases (32%) were having floating intimal flap; while the other 8 cases (16%) had residual stenosis > 30%. A primary patency rate of 92% was obtained by the end of the 12 months follow-up period.

Conclusion: Duplex can be used as a first strategy for the treatment of femoropopliteal arterial diseases. However, the pitfalls in DGA technique make it insufficient to replace the classic fluoroscopy.