Intra-arterial Doppler flowmetry in the superficial femoral artery following angioplasty

The aim of the study was to assess the diagnostic value of an intravascular Doppler guidewire in patients with peripheral percutaneous angioplasty. (P TA). The prognostic value was also evaluated. Measurements were done prior and following angioplasty in 22 patients with peripheral arterial occlusive disease. As additional therapy, stent insertion and peripheral (Aa. poplit ea Ill/tibial) angioplasty was performed (4 patients per group). For stress testing, adenosinetriphosphate (ATP) was given intra-arterially. Follow-up was performed by angiography, colour-coded duplex ultrasound or judged by unequivocal clinical stage at follow-up to 13 months. Average (APV) and max imal peak velocity (MPV) increased following PTA, after additional treatmen t (peripheral PTA or stent), and after intra-arterial application of a vaso dilator. Patients with peripheral lesions had markedly lower velocities pri or treatment and following PTA after vasodilatation. Following peripheral P TA, the values were similar to the patients with PTA alone. Velocities afte r stenting were markedly increased in the stress condition. Of the 22 patie nts, 7 had a recurrent disease. The latter patients had higher velocities a t rest prior to and following PTA. In stented lesions higher velocities see m to be linked with a worse outcome. The ratio between velocity prior to an d after the application of the vasodilator seems to be of diagnostic import ance. A ratio of 1.9 or more was of positive prognostic value. The Doppler guidewire is a practical and valuable tool in assessing technical success a fter angioplasty of peripheral lesions, critical or morphologically worse l esions. In our study the decision for stent application was made on the mor phological image; however, increased velocity and changes in phasicity subs tantiated our decisions. Increased ratios prior to and after vasodilation ( flow reserve) are of prognostic value and therefore suitable as indication for stent placement or tibial angioplasty.