Duplex Scans Performed Immediately Following Lower Extremity Angioplasty and Stenting are of Limited Utility

Abstract

ObjectiveTogether with clinical examination, surveillance duplex examination represents the SVS recommendations for follow up after endovascular intervention on the SFA and popliteal arterial segments. Compliance with post-procedural follow-up remains challenging. To establish a post-angioplasty physiologic baseline, our institution began obtaining immediate post-procedural surveillance studies following lower extremity arterial interventions. We reviewed the utility of immediate post-procedural surveillance to determine if these studies enhanced post-operative care. MethodsSerial patients undergoing SFA and popliteal angioplasty and stenting from 1/2014 to 12/2020 were identified from our prospectively maintained Vascular Surgery database. Patient demographic information, procedural details, and procedural outcomes were subsequently analyzed from the EMR. ResultsTwo hundred and sixty-three patients underwent 385 SFA and/or popliteal angioplasty/stenting interventions. Mean patient age was 64.8 ±10 years. Among these 385 procedures, 350 (90.9%) were followed by immediate (< 4 hours) post-procedural lower extremity arterial duplex scans. These 350 procedures included PTA and/or stenting of the SFA (n=236), popliteal artery (n=34), or both (n=80). Of these studies, 25 results (7.1%) were abnormal. One asymptomatic patient was admitted to hospital for immediate thrombolysis; however, the remaining 24 patients were followed clinically with no immediate intervention required. Abnormal results included 13 abnormalities appreciated on the final angiogram with 9 patients with known occlusions or stenoses, and 4 patients with mild to moderate CFA stenosis. Abnormal findings not detected on the final angiogram included 7 patients with mild to moderate stenosis and 5 patients with short occlusions (1.4%). All 5 patients with short segmental occlusions not detected on final arteriogram had pre-procedural anatomy classified as either TASC C (n=1) or TASC D (n=4). ConclusionImmediate post-procedural duplex scans demonstrate significant vessel stenosis or occlusion in approximately 7% of cases but most stenoses and occlusions were noted on final arteriography. Duplex detected short segmental occlusions not noted on final arteriography were rare (1.4%), and occurred among patients with TASC-C or -D occlusive disease. These duplex detected abnormalities rarely changed the patient’s immediate plan of care. The performance of these immediate post-procedural duplex scans demonstrated limited clinical utility.