Abstract No. 135: Ultrasound guided endovascular management of femoropopliteal artery lesions in patients with renal insufficiency

Abstract

To evaluate the early results of Ultrasound (US) guided angioplasty and stenting of femoropopliteal arteries in patients with compromised renal function. 22 patients (6 women, 16 men) with pre existing renal insufficiency were treated with US guided angioplasty/stenting for lower extremity vascular complain. Limb claudication (80%) and critical ischaemia (20 %) were the two most common presenting complains. Duplex US was performed and level and length of lesion identified in SFA and/or popliteal arteries. Besides preprocedure map, Ankle/Brachial index (ABI) was performed. Patients with only discrete lesions which could be visualized clearly by colour duplex imaging were selected. Procedure was performed under local anaesthesia and light sedation. Ipsilateral common femoral artery (CFA) was cannulated under US guidance. Heparin was administered intraarterially. Guide wire was passed across the diseased segment under US guidance. Diseased segment was balloon dilated,starting from most distal lesion. Stent was placed in 12 patients, when the diameter of diseased lumen reduced >30%. Post procedure duplex scan and ABI were performed. Follow ups were scheduled at 1 month, 3 months and 12 months. Technical success was achieved in 19 patients (86.4%). No intraoperative and postioperative complications (pseudoaneursym / haematoma at puncture site or early restenosis) were noted. No further intervention was required in the treated patients in next one year. In 3 patients (13.6%), guide wire could not be negotiated through the lesion. US guided angioplasty/ stenting appears to be safe and effective alternative technique for treatment of femorpopliteal occlusions and stenosis in patients with renal failure. Besides the two main advantages of avoiding radiation exposure (to patient and staff) and avoiding the nephrotoxic effect of contrast, US had adavantage in immediately confirming the treatment by imaging parameters, puncturing arteries under direct visualization and selection of balloon.