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

OBJECTIVE: Together 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.

METHODS: Serial 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.

RESULTS: Two 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).

CONCLUSION: Immediate 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.