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Early Hemodynamic Effects of Percutaneous Transluminal Angioplasty in Superficial Femoral Artery Disease

Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical and Vascular Unit, Imperial College School of Medicine at St. Mary's

Athanasios D. Giannoukas

Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical and Vascular Unit, Imperial College School of Medicine at St. Mary's

Nicos Volteas

Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical and Vascular Unit, Imperial College School of Medicine at St. Mary's

Aghiad Al Kutoubi

Department of Radiology, Imperial College School of Medicine at St. Mary's, London, United Kingdom

Asterios Katsamouris

Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical and Vascular Unit, Imperial College School of Medicine at St. Mary's

John H.N. Wolfe

Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical and Vascular Unit, Imperial College School of Medicine at St. Mary's

Averil O. Mansfield

Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical and Vascular Unit, Imperial College School of Medicine at St. Mary's

Andrew N. Nicolaides

Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical and Vascular Unit, Imperial College School of Medicine at St. Mary's

This study was conducted to assess the early hemodynamic effects of percutaneous trans luminal angioplasty (PTA) in patients with superficial femoral artery (SFA) atheroscle rotic disease. Seventeen patients (forty-nine to eighty-five years, median sixty-seven years), underwent PTA in the SFA, except 1 who had PTA in both the SFA and popliteal artery. Fifteen patients were claudicant whereas the other one had rest pain and ulcera tion. Ten patients had localized SFA occlusion on the angiogram (3 of them had combined stenoses in the common femoral, profunda, and popliteal arteries) and 7 had localized stenoses more than 50%. Ankle-brachial index (ABI), limb blood flow (measured by air plethysmography), peak systolic velocity (PSV) ratio across the stenosis, and the spectral waveform analysis displayed by color flow duplex imaging (CFDI) were assessed before and one day after PTA.

Before PTA, the median ABI and limb blood flow were 0.55 ±0.19 and 58.6 ±13.1 mL/min, respectively. The waveform in the poststenotic area of the SFA was monophasic in 5 patients and biphasic in the others, and the PSV was at least doubled in the stenotic area. PTA was technically successful in 16 patients and failed in 1 with an occluded SFA. After successful PTA the median ABI was 0.76 ±0.15 (P<0.00001), and the median limb blood flow was 78.1 ±11.9 mL/min (P<0.00001). The waveform in the dilated area of the SFA was biphasic in all patients with marked decrease in the PSV and forward diastolic velocity present. Postangioplasty pain-free walking distance was at least doubled in 12 patients. In the case of the failed PTA the ABI, limb blood flow, poststenotic waveform, PSV, and pain-free walking-distance were unchanged.

In conclusion, early improvement in the hemodynamic parameters occurs over the first day after a successful PTA. These hemodynamic parameters correlate well with the findings of the postangioplasty angiogram and thus can be used in the follow-up of the patients after PTA.

Vascular and Endovascular Surgery, Vol. 31, No. 5, 615-621 (1997)
DOI: 10.1177/153857449703100519


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