Complications following peripheral angioplasty: A 2 year retrospective review

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Aims: Endovascular Aneurysm Repair (EVAR) is associated with a significant re-intervention rate, for which surveillance imaging is mandatory.Duplex ultrasound (DUS) provides velocity and waveform data, yet their relationship with stent-graft limb complications remains poorly understood despite the relatively common incidence of limb kink, stenosis and occlusion.Methods: Of patients undergoing infrarenal EVAR between 2004 and 2010 those who developed a limb complication requiring re-intervention (occlusion, kinking, or DUS-defined stenosis) were identified on an intention-to-treat basis.The Peak Systolic Velocity (PSV) recorded from the proximal and distal region of each limb of the stent-graft, was extracted from serial postoperative DUS surveillance scans.Time-dependent Cox proportional hazards modelling was performed after risk adjustment.Results: 478 patients were studied, of whom 38/478 (8%) developed a limb complication.After risk adjustment, increased PSV over time within both the proximal and distal segment of the stent-graft limb was significantly associated with the risk of limb complications (Proximal Hazard ratio 1.015, 95% C.I. 1.003-1.028,p¼0.0139;Distal Hazard ratio 1.010, 95% C.I. 1.001-1.020,p¼0.0253).Conclusion: Increases in the peak systolic velocity in stent-graft limbs were associated with an increased risk of limb complication.This observation requires external validation and further investigation to define its clinical utility.

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