[Possibilities of color duplex scanning in assessment of the results of endovascular treatment of femoropopliteal arterial segment].

Abstract

Background: Lesions of the femoropopliteal segment are encountered approximately in half of patients with lower limb ischemia. With time, the strategy of treatment of such patients was changing - from open operations to endovascular interventions. However, not only the strategy of surgical treatment but also methods of examinations, as well as interpretation of their results have been revised.

Objective: The aim of our study was to assess the results of endovascular treatment for superficial femoral artery lesions using color duplex scanning.

Patients and methods: The study included a total of 93 patients with clinical manifestations of lower limb chronic ischemia, undergoing various roentgenendovascular interventions performed on the femoropopliteal segment. Color duplex scanning was used to preoperatively assess the anatomical and hemodynamic pattern of the lesion. The obtained findings were used to decide upon the scope of a surgical intervention. The examinations were then performed on POD 1 and at 6 and 12 months. Color duplex scanning made it possible not only to evaluate patency of the reconstruction zone but also to determine the length and degree of restenosis. The most important ultrasonographic criterion for in-stent restenosis was such dopplerographic parameter as the ratio of the peak systolic velocity at the portion of the maximal narrowing of the vessel lumen to the value of the peak systolic velocity in the prestenotic zone.

Results: The reconstruction zone was fully patent in 68 (74%) patients within 12 postoperative months. Color duplex scanning demonstrated a 60-65% residual stenosis in 4 (4%) patients and thrombosis of the reconstruction zone in 12 (13%) patients (of these, balloon angioplasty had been performed in 5 patients and stenting of the superficial femoral artery in 7 patients). Reconstruction zone restenosis, up to the critical one was revealed in 9 (10%) patients. Regular color duplex scanning in patients after endovascular treatment for femoropopliteal lesions contributed to diagnosis of the cause and degree of impaired patency of the reconstruction zone. The use of such dopplerographic criterion as the ratio of the peak systolic velocity made it possible to avoid the effect on the informative value of the study of such factors as the state of the central hemodynamics and multisegmentarity of the lesion, the presence of proximal and distal lesions of the arterial bed.

Conclusion: The use of the peak systolic velocity ratio gives advantages in assessment of severity of the lesion of the main artery compared with such parameter as the absolute value of the peak systolic velocity, since the peak systolic velocity ratio is independent of the central and peripheral hemodynamics and the presence of a tandem lesion. The use of the proposed criteria in assessment of the results of operation will make it possible to standardize an approach to interpretation of the data, thus decreasing the degree of operator-dependency of this method of diagnosis.