Monitoring functional patency of percutaneous transluminal angioplasty
E. V. Kinney, D. F. Bandyk, M. W. Mewissen, D. Lanza, T. M. Bergamini, E. O. Lipchik, G. R. Seabrook and J. B. Towne
Surgical Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
Duplex scanning and Doppler-derived blood pressure measurements were used
to serially monitor lower limb hemodynamics in 73 patients who underwent
percutaneous transluminal angioplasty. Ninety percutaneous transluminal
angioplasty sites judged technically satisfactory by arteriography were
evaluated. Significant hemodynamic improvement was seen in 81 (90%) of the
90 limbs, although both hemodynamic and clinical improvement were achieved
in only 77 (86%) limbs. Duplex scanning within 1 week of successful
angioplasty identified moderate (20% to 49% diameter reduction) or severe
(greater than 50% diameter reduction) residual stenosis in 49 (63%) of 77
balloon-dilated arterial segments. The presence of a greater than 50%
diameter reduction residual stenosis predicted further restenosis and late
clinical failure (11% success rate at 1 year). When the degree of residual
stenosis at the percutaneous transluminal angioplasty site was less than
50% diameter reduction by duplex scanning, the procedure was durable (80%
success rate at 2 years), even in patients with critical ischemia, poor
runoff, or diabetes mellitus.
