Improved patient selection for angioplasty utilizing color Doppler imaging

The accepted approach to patients with intermittent calf claudication is nonoperative unless the symptoms are truly incapacitating, in which case arteriography and either percutaneous angioplasty or operation is indicated. Arteriography is considered a preoperative procedure. However, with improvements in percutaneous angioplasty, we have altered our approach to those patients with limiting, but not incapacitating, claudication. These patients are given the choice of conservative treatment or percutaneous angioplasty, but not operation. In an attempt to limit arteriography to only those patients who would benefit from angioplasty, we have employed color Doppler imaging as a screening technique. Over a 2-year period, 62 patients with limiting claudication were evaluated with color Doppler imaging. Thirty-six patients had long occlusions and did not undergo arteriography since they were not believed to be candidates for percutaneous angioplasty. Three short (less than 5 cm) occlusions and 23 localized stenoses were identified in the superficial femoral and popliteal arteries. Angiography confirmed the Doppler findings in all 26 cases. In 24 patients, dilatation was successful, whereas 2 patients' arteries could not be dilated. Two stenoses recurred early and were redilated. There were no complications from the angioplasties. We conclude that in the subset of patients with limiting, but not incapacitating, claudication, color Doppler imaging can accurately select those patients who will benefit from angioplasty. In this way, patients can be spared unnecessary angiograms.