Redo Femoral-Popliteal (FP) Balloon Angioplasty Under Duplex Guidance (DG) Alone: Is It Safe?

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Anil Hingorani, M.D., natalie marks, md rvt, enrico ascher, md, alexander shiferson, md, alessandra puggioni, md.
Maimonides Medical Center, Brooklyn, NY, USA.

PURPOSE: To our knowledge redo balloon angioplasty with or without stenting under DG alone has not yet been described. This proposed approach may be important for patients with renal insufficiency or allergy to contrast material.
METHODS: Over the last 21 months we have performed 51 redo balloon angioplasties of the FP segment using DG as the sole imaging technique in 45 limbs in 42 patients. Of these, 44 were first redo and 7 second redo. Disabling claudication (63%) and tissue loss (37%) were the indications for these procedures. Time interval to first restenosis ranged from 1 to 24 months (6.5 ± 4 months) while it ranged from 2 to 13 month (6.3 ± 3.8 months) for the second restenosis. These time intervals were not statistically significant (p=0.9). All cases were performed under local anesthesia and DG using previously described techniques. Ipsilateral femoral arterial access was obtained in 45 cases (88%) and contralateral access in the remaining 6 (12%).
RESULTS: Technical success was achieved in all cases as evidenced by normalized color flow and peak systolic ratios. Stents use was deemed necessary in 41 cases (80%) either for recoil in 19 cases (46%), dissection in 13 cases (32%) or both in 9 cases (22%). There were no 1-month deaths, amputations, myocardial infarctions or strokes in this series. None of the patients had significant hematomas. Patency for the redo procedures ranged from 0 to 16 months (mean 5.5±4.3 months).
CONCLUSION: These results confirm our belief that endovascular repair of infrainguinal arterial disease can safely be performed under DG in cases of FP restenoses.

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