Technical Aspects of Infrainguinal Arterial Duplex Guided Balloon Angioplasty

Abstract

Purpose Duplex-guided balloon angioplasty (DGBA) has been reported in patients with short stenoses. We attempted to perform this procedure in patients with impaired renal function. Methods Over the course of 16 months, 37 lower-extremity DGBAs were performed at our institution in patients with renal insufficiency. Disabling claudication was the indication in 24 cases (65%) and critical ischemia in 13 cases. After duplex-guided common femoral artery (CFA) cannulation, a guide wire was directed into the origin of the superficial femoral artery, across the diseased segment and into the popliteal artery with the help of a guiding catheter under direct ultrasound visualization. The diseased segment was then dilated using a balloon. The balloon diameter and length were chosen according to arterial measurements obtained by duplex. Whenever indicated, stents were placed under duplex guidance. Results Thirty-day survival was 100%. Overall immediate technical success was achieved in all cases. Placement of intraluminal stents were deemed appropriate in 23 of 37 (62%) cases. The 1-month patency and limb salvage rates were 100%. Conclusion DGBA appears to be a feasible, safe, and effective technique for patients with renal insufficiency. Other advantages include guided puncture, accurate balloon and stent selection, and hemodynamic confirmation of the technique adequacy.