Introduction: Late lumen loss by mechanical and biological recoil is a known mechanism of restenosis and late failure post peripheral endovascular intervention. Its evaluation by non-invasive methods such as duplex ultrasound has not been formally studied.
Objectives: To determine if vessel recoil at 1 month post endovascular revascularization predicts target lesion revascularization (TLR) within 12 months of baseline procedure.
Methods: A retrospective review of 238 patients (356 tibial target lesions) from the PRIME registry who underwent tibial peripheral vascular intervention (PVI) for advanced peripheral artery disease (PAD) or critical limb ischemia (CLI) between January 2013 and August of 2016 were identified. Over a 12-month follow-up, 58 lesions were identified that required TLR and were selected for analysis. The index PVI was reviewed and for each lesion the maximal balloon inflation size was recorded as the baseline measurement. Vessel size at each discrete lesion was evaluated by averaging three separate measurements of luminal diameter (proximal, mid, and distal) on duplex ultrasound at 1-month follow-up. A control group that did not require TLR at 1 year of follow-up was otherwise randomly selected from the same 356 target-lesion cohort and the same measurements were recorded. The TLR group included 53 tibial lesions, 50 of which were evaluable by duplex ultrasound (87%). The distribution included 35 in the anterior tibial (66%), 12 in the posterior tibial (23%), and 6 in the peroneal (11%).
Results: Recoil and vessel diameter were significant predictors of reintervention within 12 months, for every 10% recoil (odds ratio, 12.76; 95% confidence interval, 11.51-14.22; P<.001). By multivariate analysis, only recoil was a significant predictor of reintervention within 12 months. A greater percentage of recoil was noted in distal vessels despite lower average inflation sizes.
Conclusions: Vessel recoil after tibial PVI evaluated at 1-month duplex ultrasound may predict TLR in advanced PAD and CLI patients over a 12-month follow-up. Multicenter analysis with a larger sample size is warranted to further validate findings.