Ultrasonography for the optimal selection of patients suitable for single session arteriography and endovascular revascularization in severe peripheral artery disease

Aims: Peripheral artery disease (PAD) represents a high burden on the healthcare and social assistance systems. Revascularization reduces symptoms, amputation rate and increases the chances of social reintegration. Our aim was to evaluate the benefits of vascular duplex ultrasonography (DUS) for identifying patients suitable for direct percutaneous transluminal angioplasty (PTA) without the need for a prior angiography. Material and methods: We included in the study 251 patients with PAD evaluated by DUS. Depending on the DUS findings the patients were split in two groups: group I, 143 patients (57%), in which selective angiography and direct PTA was performed and group 2, 108 patients (43%), in which invasive arteriography was considered necessary prior to a decision for revascularization. Results: The first group had a similar success rate (92.3% vs. 86.1%; p=0.111), but with a reduction in radioscopy time (minutes) (17.2 vs. 20.8; p=0.013), iodine contrast volume (ml) (190 vs. 227.5; p<0.001), days of hospitalization (4 vs. 7; p<0.001) and by 44.75% (p<0.001) of hospitalization costs when compared to the second group. Conclusions: DUS allows the optimal selection of patients who can benefit from direct PTA. This strategy has a high success rate, with a significant decrease in radioscopy exposure time, volume of iodine contrast needed, duration and hospitalization costs, when compared to arteriography and PTA in two different sessions.