Inadequacy of the noninvasive hemodynamic evaluation of percutaneous transluminal angioplasty

The role of noninvasive hemodynamic tests in the evaluation of percutaneous transluminal angioplasty success or failure was studied. The ankle-brachial pressure index and pulse volume recording amplitude were measured before and after 37 iliac and 46 femoropopliteal angiographically successful percutaneous transluminal angioplasties. Immediate evidence of hemodynamic improvement was seen in 53 percent of angiographically successful dilatations using the ankle-brachial pressure index and in 60 percent using the pulse volume recording amplitude alone. A better correlation was seen when improvement was noted on either test but was still only 71 percent Twelve primary iliac percutaneous transluminal angioplasties were considered to be successful immediately by angiography, yet no hemodynamic improvement was recorded. Nine primary iliac percutaneous transluminal angioplasties, however, had continued clinical success and limb viability. Twelve angiographically successful femoropopliteal percutaneous transluminal angioplasties also showed no improvement in hemodynamic values, yet three have continued clinical evidence of patency. Thus, although noninvasive hemodynamic tests are important and must be carried out, they are only one of many ways to assess the effectiveness of angioplasty.