Angioplasty of lower limb arterial stenoses under ultrasound guidance: Single-center experience

Purpose: To examine the feasibility and utility of ultrasound-guided angiop lasty for treating lower limb stenoses. Methods: Duplex ultrasonography was employed to guide 55 balloon dilation p rocedures (27 iliac, 26 superficial femoral, 1 profunda, and 1 vein graft) with the help of a special ultrasound catheter (EchoMark). Ultrasound was u sed to determine balloon size, monitor guidewire passage, direct the dilati on, and judge procedural success. Angiography was performed prior to the pr ocedure to confirm preprocedural ultrasound findings and afterward to compa re with duplex visual and hemodynamic parameters of success (peak systolic velocity ratio < 2.0). Results: The balloon size determined from duplex measurements correlated in all cases with sizes selected based on the angiographic image. Guidewire v isualization was possible in 95% of the cases. Angioplasty using ultrasound alone was feasible in 84%; inability to obtain a satisfactory image owing to vessel tortuosity, calcification, and bowel gas accounted for the failur es. Against the duplex success criterion, initial completion angiograms had an accuracy of 76%, sensitivity of 76%, and specificity of 100%. The addit ional time for ultrasound guidance averaged 42 +/- 12 minutes for all cases . Conclusions: Our results show that ultrasound guidance is feasible in routi ne clinical practice. In this series of well-selected cases of arterial ste noses, angioplasty was performed safely using ultrasound guidance alone in over 80% of the cases. Fluoroscopic monitoring is needed when ultrasound vi sualization is suboptimal.