Duplex-guided percutaneous transluminal angioplasty in iliac arterial occlusive disease

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Abstract

Background Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance. Duplex-guided infra-inguinal interventions and access-related interventions have been reported. Duplex-guided iliac interventions have not been performed to any extent because of the anatomic location. In our study we evaluated the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in iliac arteries. Methods From June 2012 until February 2013, 31 patients (35 iliac lesions), underwent DuPTA. Indications ranged from Rutherford 3 to 5. Preoperative evaluation included Ankle Brachial Index (ABI), Duplex and MRA. Procedural success was defined as crossing the lesion with a guidewire and dilating or stenting the lesion. Clinical success was defined as 50% reduction in peak systolic velocity (PSV) or clinical improvement. PSV was evaluated after PTA, then at 2 weeks. Clinical results were assessed 2 weeks after the procedure. Results Procedural success was achieved in 94% of patients (33/35), all of whom also had clinical success. Post-procedural PSV reduction showed an average improvement of 63% (431 cm/s to 153 cm/s). Mean preoperative ABI was 0.72 and improved to 0.88 postoperatively. Conclusions PTA using Duplex-guidance in significant iliac stenosis is a safe method with major advantages in patients at high risk for developing contrast-induced nephropathy. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

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Krasznai, A. G., Sigterman, T. A., Welten, R. J., Heijboer, R., Sikkink, C. J. J. M., Van De Akker, L. H. J. M., & Bouwman, L. H. (2013). Duplex-guided percutaneous transluminal angioplasty in iliac arterial occlusive disease. European Journal of Vascular and Endovascular Surgery, 46(5), 583–587. https://doi.org/10.1016/j.ejvs.2013.08.011

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