Combined Duplex Guided Angioplasty with Contrast-free Fluoroscopy for Treatment of Femoro-popliteal Arterial Lesions in Patients with Renal Insufficiency. A multicenter experience

Aborahma, Amr M.; Ebeed, Ahmed I.; El Mahdi, Ahmed M.; Korany, Ahmed O.; Ismael, Ahmed M.

doi:10.21608/asjs.2023.285726

Combined Duplex Guided Angioplasty with Contrast-free Fluoroscopy for Treatment of Femoro-popliteal Arterial Lesions in Patients with Renal Insufficiency. A multicenter experience

Document Type : Original Article

Authors

¹ Vascular Surgery Department, Faculty of Medicine, Tanta University, Egypt

² Radiology Department, Faculty of Medicine, Kafr Elshikh University, Egypt

³ Vascular Surgery Department, Faculty of Medicine, Helwan University, Egypt

⁴ General Surgery Department, Faculty of Medicine, Alexandria University, Egypt

10.21608/asjs.2023.285726

Abstract

Background: The combination of duplex guided angioplasty (DGA) and contrast free fluoroscopy can be used as
an alternative method to contrast media for the treatment of femoro-popliteal arterial occlusive diseases in renal
patients.
Patients and methods: 67 patients (38 males) with fomoro-popliteal arterial lesions underwent combined duplex
guided angioplasty with contrast-free fluoroscopy. Patients with impaired renal functions of serum creatinine level
>1.5 mg/dl and patients with hypersensitivity to contrast media were included in the study. We excluded patients
with the ability to perform classic fluoroscopy with contrast. Also, aorto-iliac or infragenicular lesions were excluded
from the study.
Results: Technical success was achieved in 63 cases (94%). In all stenotic lesions (36 cases) crossing was
achieved spontaneously using contrast free fluoroscopy. In cases with occlusion (31 cases) crossing was tried
under fluoroscopic and duplex guidance with successful transluminal crossing occurred in 19 cases of the occluded
lesions while the remaining 12 cases under went subintimal angioplasty. Successful reentry achieved in 5 cases
while 3 cases with failed reentry underwent retrograde approach through distal SFA puncture. Stenting was done
in 29 cases (43%), 19 cases (28%) were having floating intimal flap; while the other 10 cases (25%) had residual
stenosis > 30%. A primary patency rate of 91% was obtained by the end of the 1 year follow up.
Conclusion: This technique is feasible and effective for the treatment of femoropopliteal arterial lesions Patients
with renal insufficiency or allergy to contrast.

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