Lower extremity revascularization without contrast arteriography: a prospective study of operation based upon duplex mapping

This study prospectively assessed the results of lower extremity surgical r evascularization, which was performed on the basis of duplex arterial mappi ng in selected patients without preoperative contrast arteriography. Criter ia were developed for patient selection. Among 158 patients requiring surge ry for lower extremity ischemia over a 24-month period, 24 (15%) were selec ted for operation without current preoperative arteriography. Aorto-iliac a nd infrainguinal duplex arterial mapping were performed in an laboratory th at was accredited by the Intersocietal Commission for Accreditation of Vasc ular Laboratories. Indications for surgery were minor gangrene (11), rest p ain (7), or claudication (6). Operations included femoro-popliteal bypass ( 14), femoral endarterectomy (9) and femoral-femoral bypass (1). Mean length of stay was 4.5 +/- 2.0 days. Ankle-brachial index improved from 0.49 +/- 0.12 to 0.80 +/- 0.15 (P < 0.05). Primary patency was 91.7 +/- 9.4% and ass isted primary patency was 100% at 18 months. There was no graft occlusion o r limb loss. Mean follow-up was 16.7 +/- 7.0 months. These preliminary data support the safety and durability of duplex-guided lower extremity surgica l revascularization without arteriography in selected cases. Success in a b roader application of this approach requires the continuing development of patient selection criteria. (C) 1999 The International Society for Cardiova scular Surgery. Published by Elsevier Science Ltd. All rights reserved.