Lower extremity vascular reconstruction and endovascular surgery without preoperative angiography

Background: Recent studies have shown the feasibility of performing lower extremity revascularization based on noninvasive vascular studies alone. Methods: We undertook a prospective study of patients with lower extremity ischemia who underwent revascularization without preoperative angiography. Preoperative evaluation was done with noninvasive studies including segmental pressures, ankle arm index, duplex scan, and selective use of magnetic resonance angiography. Intraoperative angiography and intra-arterial pressure measurements were used prior to revascularization. Standard patency analysis and follow-up examination were performed. Results: In all, 47 patients underwent 65 procedures (27 iliac, 38 infrainguinal) over a 3-year period. Intraoperative angiography and operative findings correlated with the noninvasive studies. There was one immediate failure, and life table analysis demonstrated primary patency rates of 92% for iliac reconstruction (29 months) and 82% for infrainguinal reconstruction (40 months). Conclusion: Preoperative evaluation for lower extremity revascularization utilizing only noninvasive vascular testing gives satisfactory results and is a safe and potentially durable alternative to routine preoperative angiography in most cases.