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Ankle-arm index, angiography, and duplex ultrasonography after recanalization of occlusions in femoropopliteal arteries: Comparison of long-term results

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Abstract

Purpose

Comparison of the relative values of the ankle-arm index (AAI) at rest and after exercise, angiography, and duplex ultrasonography for the follow-up of percutaneous transluminal angioplasty (PTA) in patients with peripheral vascular disease.

Methods

Thirty-two patients were prospectively followed after technically and clinically successful PTA of a femoropopliteal occlusion. The patency of the femoropopliteal artery was assessed for 1 year using AAI measurements at rest and after exercise; duplex ultrasonography at 4, 12, 24, 36, and 52 weeks; and angiography at 3 and 12 months after PTA.

Results

Patency was highly dependent on the measurement technique. The cumulative patency after 1 year determined with the AAI at rest and during exercise, by angiography, and by duplex ultrasonography was 74%, 19%, 31%, and 32%, respectively. Seventy-five percent of the restenoses occurred at the site of the treated occlusion.

Conclusion

Duplex ultrasonography is most suitable for this assessment, as it causes no patient discomfort and the specificity is better than AAI after exercise because vascular disease in other, proximal segments does not interfere with the results.

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References

  1. van Andel GJ, van Erp WFM, Krepel MV, Breslau PJ (1985) Percutaneous transluminal dilatation of the iliac artery: Long-term results. Radiology 156:321–323

    PubMed  Google Scholar 

  2. Cambria RP, Faust G, Gusberg R, Tilson D, Zucker KA, Modlin IM (1987) Percutaneous angioplasty for peripheral arterial occlusive disease: Correlates of clinical success. Arch Surg 122: 283–287

    PubMed  CAS  Google Scholar 

  3. Colapinto RF, Harries-Jones EP, Johnston KW (1980) Percutaneous transluminal angioplasty of peripheral vascular disease: A two-year experience. Cardiovasc Intervent Radiol 3:213–218

    Article  PubMed  CAS  Google Scholar 

  4. Greenfield AJ (1980) Femoral, popliteal and tibial arteries: Percutaneous transluminal angioplasty. AJR 135:927–935

    PubMed  CAS  Google Scholar 

  5. Hewes RC, White RI, Murray RR, Kaufman SL, Chang R, Kadir S, Kinnison ML, Mitchell SE, Auster M (1986) Long-term results of superficial femoral artery angioplasty. AJR 146:1025–1029

    PubMed  CAS  Google Scholar 

  6. Jeans WD, Armstrong S, Cole S, Horrocks M, Baird RN (1990) Fate of patients undergoing transluminal angioplasty for lowerlimb ischemia. Radiology 177:559–564

    PubMed  CAS  Google Scholar 

  7. Johnston KW (1992) Femoral and popliteal arteries: Reanalysis of results of balloon angioplasty. Radiology 183:767–771

    PubMed  CAS  Google Scholar 

  8. Kaufman SL, Barth KH, Kadir S, Williams GM, Smith GW, Stonesifer GL, Leand PM, Adams PE, Wenham F, White RI (1982) Hemodynamic measurements in the evaluation and follow-up of transluminal angioplasty of the iliac and femoral arteries. Radiology 142:329–336

    PubMed  CAS  Google Scholar 

  9. Murray RR, Hewes RC, White RI, Mitchell SE, Auster M, Chang R, Kadir S, Kinnison ML, Kaufman SL (1987) Long-segment femoropopliteal stenoses: Is angioplasty a boon or a bust? Radiology 162:473–476

    PubMed  Google Scholar 

  10. Spence RK, Freiman DB, Gatenby R, Hobbs CL, Barker CF, Berkowitz HD, Roberts B, McClean G, Oleagra J, Ring EJ (1981) Long-term results of transluminal angioplasty of the iliac and femoral arteries. Arch Surg 116:1377–1386

    PubMed  CAS  Google Scholar 

  11. Waltman AC (1980) Percutaneous transluminal angioplasty: Iliac and deep femoral arteries. AJR 135:921–925

    PubMed  CAS  Google Scholar 

  12. Zeitler E, Richter EI, Seyferth W (1983) Primary results: Leg arteries. Femoropopliteal arteries. In: Dotter CT, Grüntzig A, Schoop W (eds) Percutaneous Transluminal Angioplasty. Springer, Berlin Heidelberg New York, pp 106–114

    Google Scholar 

  13. Baker JD, Dix D (1981) Variability of Doppler ankle pressures with arterial occlusive disease: An evaluation of ankle index and brachial-ankle pressure gradient. Surgery 89:134–137

    PubMed  CAS  Google Scholar 

  14. Kozloff L, Collins GJ, Rich NM, McDonald PT, Collins JT, Clagett GP (1980) Fallibility of postoperative Doppler ankle pressure in determining the adequacy of proximal arterial revascularization. Am J Surg 139:326–329

    Article  PubMed  CAS  Google Scholar 

  15. Samson RH, Sprayregen S, Veith FL, Gupta SK, Ascer E, Scher LA (1984) Inadequacy of the noninvasive hemodynamic evaluation of percutaneous transluminal angioplasty. Am J Surg 147: 212–215

    Article  PubMed  CAS  Google Scholar 

  16. May AF, DeWeese JA, Rob CG (1963) Hemodynamic effects of arterial stenosis. Surgery 53:513–524

    PubMed  CAS  Google Scholar 

  17. Carter SA (1972) Response of ankle systolic pressure to leg exercise in mild or questionable arterial disease. N Engl J Med 287:578–582

    Article  PubMed  CAS  Google Scholar 

  18. Strandness DE Jr (1990) Color. In: Strandness DE Jr (ed) Duplex Scanning in Vascular Disorders. Raven Press, New York, pp 185–195

    Google Scholar 

  19. Jager KA, Philips DJ, Martin RL, Hanson C, Roederer GO, Langlois YE, Ricketts HJ, Strandness DE (1985) Noninvasive mapping of lower limb arterial lesions. Ultrasound Med Biol 11:515–521

    Article  PubMed  CAS  Google Scholar 

  20. Kohler TR, Nance DR, Cramer MM, Vandenberghe N, Strandness DE (1987) Duplex scanning for diagnosis of aortoiliac and femoropopliteal disease: A prospective study. Circulation 76: 1074–1080

    PubMed  CAS  Google Scholar 

  21. Legemate DA, Teeuwen C, Hoeneveld H, Ackerstaff RGA, Eikelboom BC (1991) Value of duplex scanning compared with angiography and pressure measurement in the assessment of aortoiliac arterial lesions. Br J Surg 78:1003–1008

    Article  PubMed  CAS  Google Scholar 

  22. Sacks D, Robinson ML, Marinelli DL, Perlmutter GS (1990) Evaluation of the peripheral arteries with duplex US after angioplasty. Radiology 276:39–44

    Google Scholar 

  23. Mewissen MW, Kinney EV, Bandyk DF, Reifsnyder T, Seabrook GR, Lipchik EO, Towne JB (1992) The role of duplex scanning versus angiography in predicting outcome after balloon angioplasty in the femoropopliteal artery. J Vasc Surg 15:860–866

    Article  PubMed  CAS  Google Scholar 

  24. Kinney EV, Bandyk DF, Mewissen MW, Lanza D, Bergamini TM, Lipchik EO, Seabrook GR, Towne JB (1991) Monitoring functional patency of percutaneous transluminal angioplasty. Arch Surg 126:743–747

    PubMed  CAS  Google Scholar 

  25. Rutherford RB (1991) Standards for evaluating results of interventional therapy for peripheral vascular disease. Circulation [Suppl I] 83:6–11

    Google Scholar 

  26. Bruce RA (1971) Exercise testing of patients with coronary heart disease: Principles and normal standards for evaluation. Ann Clin Res 3:323–332

    PubMed  CAS  Google Scholar 

  27. Yao ST, Hobbs JT, Irvine WT (1969) Ankle systolic pressure measurement in arterial disease affecting the lower extremities. Br J Surg 56:676–679

    Article  PubMed  CAS  Google Scholar 

  28. Strandness DE Jr (1986) Ultrasound in the study of atherosclerosis. Ultrasound Med Biol 12:453–464

    Article  PubMed  Google Scholar 

  29. Goldman AJ, Elwood JM (1979) Examining survival data. Can Med Assoc J 121:1065–1071

    Google Scholar 

  30. Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto J, Smith PG (1976) Design and analysis of each patient. Br J Cancer 34:585–612

    PubMed  CAS  Google Scholar 

  31. Carter SA (1969) Clinical measurement of systolic pressures in limbs with arterial occlusive disease. JAMA 207:1869–1874

    Article  PubMed  CAS  Google Scholar 

  32. Breslau PJ, Joming PJG, Greep JM (1985) Assessment of aortoiliac disease using hemodynamic measures. Arch Surg 120:1050–1052

    PubMed  CAS  Google Scholar 

  33. Sumner DS (1986) Noninvasive measurement of segmental arterial pressure. In: Zwiebel WJ (ed) Wascular Ultrasonography. Grune and Statton, Orlando, pp 281–286

    Google Scholar 

  34. Sumner DS, Strandness DE (1969) The relationship between calf blood flow and ankle blood pressure in patients with intermittent claudication. Surgery 65:763–771

    PubMed  CAS  Google Scholar 

  35. Probst P, Cerny P, Owens A, Mahler F (1983) Patency after femoral angioplasty: Correlation of angiography appearance with clinical findings. AJR 140:1227–1232

    PubMed  CAS  Google Scholar 

  36. Sumner DS, Strandness DE Jr (1970) The effect of exercise on resistance to blood flow in limbs with an occluded superficial femoral artery. Vasc Surg 4:229–237

    PubMed  CAS  Google Scholar 

  37. Moore WS, Hall AD (1971) Unrecognized aortoiliac stenosis: A physiologic approach to the diagnosis. Arch Surg 103:633–638

    PubMed  CAS  Google Scholar 

  38. Legemate DA, Teeuwen C, Hoeneveld H, Ackerstaff RGA, Eikelboom BC (1989) The potential of duplex scanning to replace aortoiliac and femoropopliteal angiography. Eur J Vasc Surg 3:49–54

    Article  PubMed  CAS  Google Scholar 

  39. Barnes RW (1991) Noninvasive diagnostic assessment of peripheral vascular disease. Circulation 83:20–27

    Google Scholar 

  40. Creasy TS, McMillan PJ, Fletcher EWL, Collin J, Morris PJ (1990) Is percutaneous transluminal angioplasty better than exercise for claudication? Preliminary results from a prospective randomised trial. Eur J Vasc Surg 4:135–140

    Article  PubMed  CAS  Google Scholar 

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Winter-Warnars, H.A.O., van der Graaf, Y. & Mali, W.P.T.M. Ankle-arm index, angiography, and duplex ultrasonography after recanalization of occlusions in femoropopliteal arteries: Comparison of long-term results. Cardiovasc Intervent Radiol 19, 234–238 (1996). https://doi.org/10.1007/BF02577641

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