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Chapter 54. Peripheral Arterial Disease

According to the authors, which of the following statements regarding duplex ultrasound uses for surveillance after endovascular revascularization of the femoropopliteal territory is true?

A. Duplex ultrasound examination is warranted when claudication or signs of critical limb ischemia recur.

B. Duplex ultrasound examination is recommended to monitor for restenosis 6 and 12 months after revascularization.

C. Duplex ultrasound examination is recommended to monitor restenosis within 1 month after the procedure, at 3 and 6 months, and then once a year after revascularization.

D. Concomitant ankle-brachial index (ABI) is recommended 6 and 12 months after procedure.

The correct answer is C

Patients undergoing lower extremity revascularization with endovascular techniques require a baseline ABI and a duplex ultrasound examination of the treated vascular segment within 1 month of the procedure. In addition to the baseline study, the authors routinely repeat the ABIs and duplex ultrasound examinations at 3 and 6 months after the endovascular intervention to monitor for patency of the target vessel site. Patients are at highest risk for restenosis during the first 6 months after the procedure, and symptoms of recurrent disabling claudication may occur too late, after (re)occlusion of the index lesion. Repeat revascularization of a completely occluded artery from restenosis is expected to be difficult and time consuming, while also exposing both the patient and the operators to excessive direct radiation; therefore, early detection of physiologic (ABI/ pulse volume recording [PVR]) or anatomic (duplex ultrasound) signs of significant restenosis will permit planning for re-intervention, before progression to a total occlusion.

Surgical treatment of symptomatic common and external iliac artery stenosis should be considered in all of the following conditions, EXCEPT:

A. 100% flush occlusion of the ostium of the common iliac artery with severe calcification and no “beak” at the origin of the diseased segment

B. 6.5-cm concomitant abdominal aortic aneurysm (AAA)

C. 100% occlusion of the distal abdominal aorta

D. Lack of contralateral or ipsilateral femoral access

The correct answer is D

Most patients with symptomatic common and external iliac artery stenosis are treated using endovascular techniques unless: (1) there is an infrarenal AAA requiring repair; (2) there is a 100% flush occlusion with no “beak” or “nubbin” at the ostium of the common iliac artery and there is severe calcification and intermediate (>5 cm) length occlusion; or (3) there is a long occlusion (>10 cm) with severe calcification.

The decision to use endovascular techniques versus open ...

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