Percutaneous transluminal angioplasty of the tibial arteries (original) (raw)
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Journal of Vascular and Interventional Radiology, 2012
Purpose: To evaluate the technical success and clinical long-term effectiveness of percutaneous transluminal angioplasty (PTA) of the infrapopliteal arteries in critical limb ischemia (CLI) and to determine if total vessel dilation (TVD) increases the limb salvage rate (LSR). Materials and Methods: A retrospective study was performed in 90 consecutive patients (35 men and 55 women, median age 79 years, standard deviation [SD] 9 years) over a 5.5-year period to determine the effectiveness of infrapopliteal PTA in treating CLI. Of 90 patients, 61 underwent TVD. Analysis of LSR was performed using the Kaplan-Meier life-table analysis. Results: In 90 limbs, there were 57 infrapopliteal stenoses and 104 occlusions. Including 10 technical failures (TF) (TF ϭ 11%), LSR at 1 year and 3 years for all 90 patients with previously untreated lesions was 78%. For 80 technically successful (TS) procedures (TS ϭ 89%), LSR at 1 year and 3 years was 87%. At 1 year and 3 years, LSR for the 61 patients who had TVD was 89%. In all patients, there were no amputations after the first year. The 30-day mortality rate was 7%. Conclusions: PTA of the infrapopliteal arteries appears to be an effective treatment for patients with CLI. TVD provides an improved LSR and warrants additional evaluation. ABBREVIATIONS ATK ϭ above the knee, BTK ϭ below the knee, CLI ϭ critical limb ischemia, LSR ϭ limb salvage rate, PTA ϭ percutaneous transluminal angioplasty, SFA ϭ superficial femoral artery, TF ϭ technical failure, TS ϭ technical success, TVD ϭ total vessel dilation From the Department of Radiology (H.O., A.v.d.
Vascular and endovascular surgery, 2010
To compare the results of percutaneous transluminal angioplasty (PTA) and bypass graft surgery (BGS) for the treatment of infrapopliteal lesions in individuals presenting with critical limb ischemia (CLI). A total of 48 infrapopliteal PTAs and 50 infrapopliteal BGS were compared retrospectively. All grafts used nonreversed saphenous vein in a single length as a substitute. Secondary patency and limb salvage rates in 24 months for the surgical group were 64.7% and 73.2%, respectively. For PTA group, these values were 63.7% and 68.2%, without differences between groups (log rank; P = .45 and .39, respectively). Bypass graft surgery presented better results of secondary patency (72.9% vs 57.1%) and limb salvage (83.5% vs 53.6%) than PTA for patients with Transatlantic Inter-Society Consensus (TASC) D lesions (P = .04 and P = .01, respectively). Both BGS and PTA provided similar results of patency and limb salvage for individuals with infrapopliteal atherosclerotic disease presenting wi...
Clinical Outcome of Infrapopliteal Angioplasty for Treatment of Chronic Lower Limb Ischemia
2019
Background: Chronic lower limb arterial stenosis is a condition that impairs the quality of life and could result in amputation. One of the major treatments is angioplasty to open the stenosis. Objectives: We evaluated the midterm results of endovascular treatment of infra popliteal arterial disease as a primary intervention to reduce the level of ischemia in order to avoid major amputation. Patients and Methods: Between March 2013 and April 2015, we collected all data of patients who underwent infrapopliteal angioplasty for chronic limb ischemia (CLI), (Rutherford category 4,5, or 6). The outcome as freedom from reintervention, limb salvage, improvement of signs and symptoms, and the overall survival was analyzed. We reviewed the results of angioplasty by anatomic characteristics of the lesion, transatlantic intersociety characteristics (TASC). Results: Forty seven patients were enrolled in this study of whom 37 were male. Mean age was 67.2 years. Mean ankle brachial index (ABI) before and 6 months after percutaneous transluminal angioplasty (PTA) was 0.5 ± 0.07 and 0.68 ± 0.12, respectively (P < 0.01) and an improved ABI of at least 0.1 was detected in 78% of the patients. In 97.2%, initial technical success was obtained. Rest pain was completely resolved in 66.7% of the patients after the 3-month follow-up and 72.7% after the 6-month follow-up after the procedure. Complete or relative healing of chronic ulcer was seen in 69% and 92% of patients in the 3-and 6-month follow-up after the procedure, respectively. Restenosis occurred in four patients (8.5%), major amputation in 19.1% (9 patients) and the mortality rate was 25.1% (12 cases). Primary patency was finally estimated as 76.1%. Conclusions: PTA for infrapopliteal lesions in high-risk patients can reduce the risk of amputation with a lower mortality and morbidity.
European Journal of Vascular and Endovascular Surgery
WHAT THIS PAPER ADDS This article is a unique randomised clinical trial design to analyse the volume concept in infrapopliteal revascularisation. In this paper, the treatment of more than one artery improved the speed of wound healing. This result may influence clinical practice because it confirms the benefit of opening more than one artery in favourable cases. Objective: The aim was to analyse the effect of the treatment of more than one infrapopliteal artery with respect to wound healing and limb salvage. Methods: Seventy-eight patients were enrolled prospectively for 80 procedures (80 limbs) that were randomly divided into two groups: 40 in the single vessel (SV) group and 40 in the multiple vessel group (MV). All patients had tissue loss. The choice of the first artery to treat was based on an analysis of two factors: the ease of the required endovascular technique and the presence of adequate distal outflow. The randomisation point was after the first successful distal artery angioplasty. The primary endpoints were the wound healing rate and limb salvage. Results: The mean age of the patients was 69.1 AE 4.3 years, and 56% were male. Concomitant treatment of the femoral and popliteal arteries was performed in 38.8% of patients. All demographic characteristics and technical aspects were statistically comparable for both groups. Successful recanalisation was achieved in 95.8%, 86.2%, 86.9%, and 92.5% for the tibio-fibular trunk, anterior tibial, posterior tibial, and fibular artery, respectively. In the MV group, a higher contrast volume (29 mL more; p ¼ .049), longer procedure time (p ¼ .01), and higher radiation exposure (p ¼ .04) were noted. There was no difference in renal function between the groups either before or 30 days after the procedure (p ¼ .165). The limb salvage rates after 1 and 3 years, respectively, were 75.9% and 67% for the SV group and 91.1% and 91.1% for the MV group (log rank p ¼ .052). The wound healing rates after 1 and 3 years, respectively, were 33.6% and 70.9% for the SV and 63.9% and 78.4% for MV group (log rank p ¼ .006). Wound healing was faster in MV (2.11 cm 2 /month) than SV group (0.62 cm 2 /month; p ¼ .004). Conclusion: Endovascular treatment of more than one artery was associated with better wound healing rates but not with better limb salvage.
Infrapopliteal percutaneous transluminal angioplasty for limb salvage
Acta Radiologica, 2000
Purpose: To evaluate long-term results of infrapopliteal percutaneous transluminal angioplasty (PTA) for limb salvage. Material and Methods: A retrospective study of 71 consecutive infrapopliteal PTAs in 49 patients with rest pain (n = 20) or ulceration (n = 29) was conducted. In 18 patients, surgical minor amputation or debridment was also performed. Results: Technical success was achieved in 45 patients. Four failures necessitated 2 amputations. One patient died in the postoperative course. Global morbidity rate was 16%, including minor complications in 5 patients and major vascular complications in 3 patients. After technical success during the follow-up (median duration 21 months), restenoses occurred in 4 patients, of whom 3 had a successful re-PTA (clinical success rate 72%). Survival, primary patency, secondary patency and limb salvage rates were, respectively, 75%, 81%, 88% and 87% after 3 years. The only positive predictive factor for primary patency was the presence of dia...
Journal of Vascular Surgery, 2008
Purpose: Though the peroneal artery (PA) often remains patent despite disease or occlusion of other infrapopliteal arteries, there is skepticism about using the terminal PA as the outflow tract in distal revascularizations for limb salvage, especially when a patent inframalleolar artery is available. We analyzed our experience of using the distal PA and inframalleolar or pedal branches arteries as outflow tracts in revascularizations for critical limb ischemia. Methods: Over a decade, among 651 infrapopliteal arterial reconstructions performed in 597 patients, the PA was the outflow vessel in 214, its distal third being involved in 69 vein revascularizations (study group). During the same period, 187 vein bypass grafts were performed to 179 inframalleolar and 8 pedal branches arteries (control group). Patency, limb salvage and survival rates were assessed using Kaplan-Meier life-table analysis. Complete follow-up (range, 0.1-10.2 years; mean, 5.8 years) was obtained in 245 (95.7%) patients (66 were in the study group). Results: The distal PA was chosen as the target vessel: (1) because the proximal, mid-PA was occluded or severely diseased and no other adequate inframalleolar or pedal branches arteries were identified preoperatively (n ؍ 30; 43.5%);
Effect of inflow and outflow sites on the results of tibioperoneal vein grafts
The American Journal of Surgery, 1986
Traditionally, the common femoral artery has served as the inflow origin to distal tibial vein grafts even if the popliteal segment is patent and in continuity with the common femoral artery. This is probably due to the concern that the superficial femoral artery is often affected by atherosclerosis and that using the distal part of it or the popliteal artery as inflow is doomed to failure due to progression of the atherosclerotic process. These common femoral artery-to-tibial or femoral-to-peroneal artery bypasses have reported patency and limb salvage rates of 56 and 69 percent, respectively [I]. Recently, Veith et al [2] reported their success rates in tibial reconstruction using either the distal superficial femoral or the popliteal artery as the inflow site, with a 6 year patency rate of 69 percent. Schuler et al reported 84 percent patency and 70 percent limb salvage at 3 months with popliteal-to-distal bypass grafts using primarily reversed saphenous vein. These excellent results prompted us to compare the cumulative patency rate in two groups of patients with tibial or peroneal artery bypasses. In Group I, the bypass graft originated from the common femoral artery whereas in Group II, the bypass originated from the distal superficial femoral or popliteal artery. Furthermore, we considered the effect of the outflow or distal anastomosis on long-term graft patency. This was spurred by controversy over the suitability of the peroneal artery as an outflow vessel [4-q. Therefore, we reviewed our patency and limb salvage rates for all tibial vessel grafts as related to the site of distal anastomosis.