Privilege of adding noncontrast fluoroscopy to the standard duplex ultrasound-guided percutaneous transluminal angioplasty: a comparative study

Background
The use of contrast agents in the context of conventional percutaneous transluminal angioplasty (PTA) may pose considerable risks for patients with pre-existing renal impairment, and/or allergic disorders. Duplex ultrasound-guided PTA is one of the established alternative modalities to avoid the risk for contrast use; however, it has its limitations.
Aim
The aim of the present study was to address the values of combining noncontrast fluoroscopy to duplex ultrasound-guided PTA to overcome the limitations of using the later alone, and to improve the overall outcome.
Patients and methods
The study was conducted from January 2012 to October 2014 on a total of 32 patients with severe chronic ischemia mainly due to significant femoropopliteal disease, with concomitant iliac and/or tibial lesions in some of them. Patients were randomized equally between two groups, duplex ultrasound-guided PTA and combined noncontrast fluoroscopy and duplex ultrasound-guided PTA. Both groups were compared regarding technically related points and also 6 and 12-month patency rates.
Results
In the duplex ultrasound-guided PTA group, the technical success rate was achieved in 13/16 (81.2%) patients. Balloon angioplasty was carried out in nine patients (eight with noncompliant balloon); stenting was needed in three patients, whereas hybrid treatment was needed in one patient. At 6 and 12 months, primary patency rates were 76.9 and 61.5%, respectively. In contrast, in the combined noncontrast fluoroscopy and duplex ultrasound-guided PTA group, technical success rate was achieved in 15/16 (87.5%) patients. Balloon angioplasty was carried out in 11 patients (seven with noncompliant balloon); stenting was needed in two patients whereas hybrid treatment was needed in two other patients. At 6 and 12 months, primary patency rates were 80 and 66.6%, respectively.
Conclusion
In this study, a pioneer step forward was assumed to improve the overall technicality in such situations by adding noncontrast fluoroscopic guidance to duplex guided-PTA, with significantly better periprocedural outcome.