Utility Of Duplex Scans Performed Immediately Following Angioplasty And Stenting
Anup P. Sanghvi, BS, Morgan Messner, NP-BC, Francisco Albuquerque, MD, Daniel Newton, MD, Robert Larson, MD, Mark Levy, MD.
Virginia Commonwealth University Health System, Richmond, VA, USA.
OBJECTIVES: Together with clinical examination, surveillance duplex and ABIs comprise the SVS recommendations for follow up after SFA/popliteal arterial intervention. However, compliance with post-procedural follow-up is a well-documented challenge. Our institution has adopted the practice of obtaining immediate post-procedural surveillance studies following lower extremity arterial intervention. We reviewed the utility of immediate post-procedural surveillance to discern if they changed or enhanced post-operative care along with compliance.
METHODS: Serial patients undergoing SFA and popliteal angioplasty and stenting from 1/2014 to 12/2020 were identified from our Vascular Surgery database. Patient demographic information and procedural details and outcomes were analyzed from the EHR.
RESULTS: Two hundred and sixty-three patients underwent 385 SFA and/or popliteal angioplasty/stenting interventions. Mean patient age was 65±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, 32 results (9.1%) were physiologically concerning (see table below). One asymptomatic patient was admitted to hospital for immediate thrombolysis; however, the remaining 31 patients were followed clinically with no immediate intervention required. Patient mortality was 4.6% (12/263) at 6 months, 8% (21/263) at 1 year, and 20% (53/263) overall.
CONCLUSIONS: Our experience demonstrates that immediate post-procedural duplex scans demonstrate significant vessel stenosis or occlusion in approximately 9% of cases. However, these abnormalities rarely changed the patient’s immediate plan of care. Occasional instances of asymptomatic stent occlusion may be more effectively treated if detected by immediate duplex. Performance of immediate post-procedural duplex likely also increases compliance in performing these studies.
| Physiologic Concern | Number |
| Stenosis (PSV > 300 cm/s) | 19 |
| Occlusion | 10 |
| Stenosis + Occlusion | 2 |
| Dissection | 1 |
| Total Concerning Duplex Scans | 32 |
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