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Background This prospective pilot study compared the diagnostic accuracy of duplex scanning and pulse-generated run-off (PGR) with intra-arterial digital subtraction angiography (IADSA) for assessment of popliteal, crural and pedal arteries, and explored the reliability of investigation with the combination of duplex scanning and PGR in patients who needed femorodistal reconstruction.
Methods In 23 limbs, 345 arterial segments were graded independently with duplex scanning and IADSA as normal, stenosed or occluded and compared using weighted kappa analysis. PGR was rated as good, poor or no run-off and compared with pedal arch patency on IADSA. Based on information derived from duplex scanning and PGR a vascular surgeon proposed treatment and the distal anastomosis site for bypass, which was compared with definitive treatment as determined by IADSA.
Results Overall agreement between duplex scanning and IADSA for popliteal and crural arteries was moderate (kappa 0·47, 95 per cent confidence interval (c.i.) 0·39-0·55) with best agreement within the popliteal and proximal tibial arteries. Agreement within pedal arteries was fair (kappa 0·35, 95 per cent c.i. 0·17-0·53). PGR detected good run-off in five of 21 pedal arteries shown to be occluded on IADSA. In 16 of 23 patients treatment based on duplex scanning and PGR was identical to that based on IADSA. Eight of eleven femoropopliteal bypasses were predicted accurately.
Conclusion Operative strategy could have been based on investigation by duplex scanning and PGR in a substantial number of patients scheduled for femoropopliteal bypass surgery. Agreement between duplex scanning and IADSA within very distal arterial segments was fair.

Objectives:: To determine intravascular ultrasound parameters related to restenosis following percutaneous transluminal balloon angioplasty (PTA) of the femoropopliteal artery. Design:: Prospective study. Materials and methods:: Patients were studied with intravascular ultrasound before and after angiographic successful PTA (n = 114). Intravascular ultrasound cross-sections obtained with 1 cm interval in the dilated segment were analysed. A distinction was made between anatomic (duplex scanning) and clinical (Rutherford criteria) restenosis assessed within 1 month and at 6 months after PTA. Results:: Intravascular ultrasound predictors of 1 month anatomic outcome were lumen area stenosis after PTA, lumen area increase, plaque area decrease, and area stenosis decrease; predictor of 6 months anatomic outcome was area stenosis after PTA. Multivariate analysis revealed that area stenosis after PTA was the only independent predictor of both 1 and 6 months anatomic outcome. Intravascular ultrasound predictors of 1 month clinical outcome were the presence of hard lesion and the mean arc of hard lesion. Multivariate analysis revealed that the mean arc of hard lesion was the only independent predictor of 1 month clinical outcome. No predictors for 6 months clinical outcome were found. Conclusions:: Intravascular ultrasound can elucidate parameters predictive of restonosis after PTA. The strongest intravascular ultrasound parameter predictive of anatomic restenosis was a larger area stenosis after PTA.

Objective:: To study the effects of balloon angioplasty (PTA) of the femoropopliteal artery with intravascular ultrasound (IVUS). Materials and methods:: Corresponding IVUS cross-sections (n = 1033) obtained before and after PTA from 115 procedures were analysed. Vascular damage including plaque rupture, dissection and media rupture was assessed. Free lumen area (FLA), media-bounded area (MBA) and plaque area (PLA) were measured. Results:: After PTA vascular damage was seen at the target site in 83 (72%) arteries: plaque rupture in 30 (26%), dissection in 66 (57%) and media rupture in 20 (17%) arteries. The FLA increased from 5.4 +/- 3.4 mm^2 to 14.1 +/- 5.0 mm^2 (p<0.001), MBA increased from 26.9 +/- 10.0 mm^2 to 32.9 +/- 10.7 mm^2 (p<0.001) and PLA decreased from 21.6 +/- 8.5 mm^2 to 18.8 +/- 8.0 mm^2 (p<0.001). The increase in MBA accounted for 68% of lumen gain. The frequency of vascular damage and the relative contribution of MBA increase and PLA decrease to luminal gain were not different in procedures with balloon diameter @? 5 mm and >= 6 mm. Conclusions:: Vascular damage is common following PTA. Lumen gain is mainly due to vessel expansion and, to a lesser extent, to a decrease in plaque area.

To compare the diagnostic accuracy of duplex scanning (DS) and pulse generated run-off (PGR) with ia-DSA for the assessment of cruropedal outflow and explore the reliability of clinical decision making based on a work-up with DS/PGR in candidates for peripheral bypass surgery.