RECANALIZATION OF FEMOROPOPLITEAL OCCLUSIVE LESIONS - A COMPARISON OFLONG-TERM CLINICAL, COLOR DUPLEX US, AND ARTERIOGRAPHIC FOLLOW-UP

PURPOSE: To assess the merits of clinical examination, color-flow dupl ex ultrasound (US), and arteriography in the follow-up of patients who have undergone femoropopliteal artery recanalization for occlusive di sease. PATIENTS AND METHODS: Recanalization of the occluded femoropopl iteal artery was attempted in 62 patients. Follow-up included clinical examination, ankle-brachial blood pressure measurement, and duplex US scanning at 4-month intervals during the first year, at 6-month inter vals during the second year, and once a year thereafter. Failure of re canalization included substantial restenosis or reocclusion of the tre ated segment. Arteriography was performed at the end of the first year or earlier if recurrence was suspected. Agreement of clinical finding s with those of duplex US and those of arteriography was determined wi th kappa statistics; a kappa value of greater than 0.75 represented ex cellent agreement. RESULTS: Recanalization was technically successful in 51 patients (82%). Clinical patency was 63% (standard error [SE], 6 %) after 1 year, 56% (SE, 7%) after 2 years, and 46% (SE, 9%) after 3 years. When technical failures were included, the patency rate at dupl ex US was 58% (SE, 6%) after 1 year, 40% (SE, 7%) after 2 years, and 3 3% (SE, 8%) after 3 years. The patency rate at arteriography was 53% ( SE, 7%) after 1 year, 33% (SE, 7%) after 2 years, and 30% (SE, 8%) aft er 3 years. When arteriographic examination was considered the standar d of reference, diagnostic accuracy in the identification of recurrent lesions was 94% at duplex US (kappa = 0.88) and 74% at clinical exami nation (kappa = 0.51). CONCLUSION: Rates of restenosis or occlusion de tected at followup with duplex US and arteriography were comparable. H owever, clinical examination alone helped detect fewer cases of recurr ent disease.