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CardioVascular and Interventional Radiology

, Volume 26, Issue 3, pp 251–255 | Cite as

Clinical Outcome Following Infra-Inguinal Percutaneous Transluminal Angioplasy for Critical Limb Ischemia

  • Miltiadis I. Matsagas
  • Marco A. Rivera
  • Tan Tran
  • Adam Mitchell
  • Peter Robless
  • Alun H. Davies
  • George GeroulakosEmail author
Clinical Investigations

Abstract

Objective: The aim of this study was to assess the efficacy and durability of infra-inguinal PTA in patients with CLI, in terms of clinical outcome. Design: Retrospective study of 50 consecutive patients with CLI that were exclusively treated by infra-inguinal PTA. Methods: The indications for intervention were rest pain in seven (14%) patients, non-healing ulcers in 27 (54%), and gangrenous lesions in 16 (32%). Thirty-three (66%) of these patients presented with a single arterial lesion, and the remaining 17 (34%) with multilevel arterial lesions. Kaplan-Meier analysis was used to assess survival, patency, limb-salvage rates, and amputation-free survival. Results: A total of 67 endovascular procedures were performed and 59 (88.1%) of them were considered to be technically successful. The median follow-up period was 12 months (interquartile range: 17 months). The 30-day mortality was 4%, while the cumulative survival rates at 12, 24, and 36 months were 73%, 67%, and 59%, respectively. The cumulative primary patency rates at 12 and 24 months were 63% and 52%, respectively, and remained unchanged thereafter. The estimated secondary patency rate was 72% at 36 months. There was only one below-knee amputation in the patients that were treated exclusively with infra-inguinal PTA. The cumulative amputation-free survival at the same period was estimated at 60%. Conclusions: Infra-inguinal PTA had a good early and late outcome in this series of patients with a limited life expectancy. These results are comparable to historical results of surgical revascularization in the treatment of CLI. There is need for a randomized study to determine the primary optimal interventional approach for patients with CLI.

Keywords

Peripheral Arterial Disease Patency Rate Critical Limb Ischemia Arterial Segment Endovascular Procedure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Dormandy, J, Rutherford, R 2000Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC).J Vasc Surg31S1S296PubMedGoogle Scholar
  2. 2.
    Hunink, M, Wong, J, Donaldson, M, Meyerovitz, MF, de Vries, J, Harrington, DP 1995Revascularization for femoropopliteal disease. A decision and cost-effectiveness analysis.JAMA274165171CrossRefPubMedGoogle Scholar
  3. 3.
    Parsons, RE, Suggs, WD, Lee, JJ, Sanchez, LA, Lyon, RT, Veith, FJ 1998Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: Do the results justify an attempt before bypass grafting?J Vasc Surg2810661071PubMedGoogle Scholar
  4. 4.
    London, NJ, Varty, K, Sayers, RD, Thompson, MM, Bell, PR, Bolia, A 1995Percutaneous transluminal angioplasty for lower-limb critical ischaemia.Br J Surg8212321235PubMedGoogle Scholar
  5. 5.
    Lofberg, A, Lorelius, L, Karacagil, S, Westman, B, Almgren, B, Berggvist, D 1996The use of below-knee percutaneous transluminal angioplasty in arterial occlusive disease causing chronic critical limb ischemia.Cardiovasc Intervent Radiol19317322CrossRefPubMedGoogle Scholar
  6. 6.
    Blair, J, Gewertz, B, Moosa, H, Lu, CT, Zarins, CK 1989Percutaneous transluminal angioplasty versus surgery for limb-threatening ischemia.J Vasc Surg9698703CrossRefPubMedGoogle Scholar
  7. 7.
    Matsi, P, Manninen, H, Suhonen, M, Pirjnen, AG, Soimakallio, S 1993Chronic critical lower-limb ischemia: Prospective trial of angioplasty with 1–36 months follow-up.Radiology188381387PubMedGoogle Scholar
  8. 8.
    Varty, K, Nydahl, S, Nasim, A, Bolia, A, Bell, PR, London, JM 1998Results of surgery and angioplasty for the treatment of chronic severe lower limb ischaemia.Eur J Vasc Endovasc Surg16159163PubMedGoogle Scholar
  9. 9.
    Boyer, L, Therre, T, Garcier, J, Perez, N, Ravel, A, Privat, C, Viallet, JM 2000Infrapopliteal percutaneous transluminal angioplasty for limb salvage.Acta Radiol417377CrossRefPubMedGoogle Scholar
  10. 10.
    Currie, I, Wakeley, C, Cole, S, Wyatt, MG, Scott, DJ, Baird, RN, Horrocks, M 1994Femoropopliteal angioplasty for severe limb ischaemia.Br J Surg81191193PubMedGoogle Scholar
  11. 11.
    Rutherford, R, Baker, J, Ernst, C, Johnston, KW, Porter, JM, Ahn, S, Jones, DN 1997Recommended standards for reports dealing with lower extremity ischemia: Revised version.J Vasc Surg26517538PubMedGoogle Scholar
  12. 12.
    Martin, D, Katz, S, Kohl, R, Qian, D 1999Percutaneous transluminal angioplasty of infrainguinal vessels.Ann Vasc Surg13184187CrossRefPubMedGoogle Scholar
  13. 13.
    Lofberg, A, Karacagil, S, Ljungman, C, Westman, B, Bostrom, A, Hellberg, A, Ostholm, G 2001Percutaneous transluminal angioplasty of the femoropopliteal arteries in limbs with chronic critical lower limb ischemia.J Vasc Surg34114121CrossRefPubMedGoogle Scholar
  14. 14.
    Dorros, G, Jaff, M, Murphy, K, Mathiak, L 1998The acute outcome of tibioperoneal vessel angioplasty in 417 cases with claudication and critical limb ischemia.Cathet Cardiovasc Diagn45251256CrossRefPubMedGoogle Scholar
  15. 15.
    Rafferty, T, Avellone, J, Farrell, C, Hertzer, NR, Plecha, FR, Rhodes, RS, Sharp, WV, Rogers, JM 1987A metropolitan experience with infrainguinal revascularization. Operative risk and late results in northeastern Ohio.J Vasc Surg6365371CrossRefPubMedGoogle Scholar
  16. 16.
    Varty, K, Nydahl, S, Butterworth, P, Errington, M, Bolia, A, Bell, PR, London, NI 1996Changes in the management of critical limb ischaemia.Br J Surg83953956PubMedGoogle Scholar
  17. 17.
    Karch, L, Mattos, M, Henretta, J, McLafferty, RB, Ramsey, DE, Hodgson, KJ 2000Clinical failure after percutaneous transluminal angioplasty of the superficial femoral and popliteal arteries.J Vasc Surg31880887PubMedGoogle Scholar
  18. 18.
    Ray, S, Minty, I, Buckenham, T, Belli, AM, Taylor, RS, Dormandy, JA 1995Clinical outcome and restenosis following percutaneous transluminal angioplasty for ischaemic rest pain or ulceration.Br J Surg8212171221PubMedGoogle Scholar
  19. 19.
    Treiman, G, Treiman, R, Ichikawa, L, Van Allan, R. 1995Should percutaneous transluminal angioplasty be recommended for treatment of infrageniculate popliteal artery or tibioperoneal trunk stenosis?J Vasc Surg22457465PubMedGoogle Scholar
  20. 20.
    Dormandy, J, Heeck, L, Vig, S 1999The fate of patients with critical leg ischemia.Semin Vasc Surg12142147PubMedGoogle Scholar
  21. 21.
    Dorros, G, Jaff, MR, Dorros, AM, Mathiak, LM, He, T 2001Tibioperoneal (outflow lesion) angioplasty can be used as primary treatment in 235 patients with critical limb ischemia: Five-year follow-up.Circulation10420572062PubMedGoogle Scholar
  22. 22.
    Nasr, MK, McCarthy, RJ, Hardman, J, Chalmers, A, Horrocks, M 2002The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia.Eur J Vasc Endovasc Surg23398403CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 2003

Authors and Affiliations

  • Miltiadis I. Matsagas
    • 1
    • 2
  • Marco A. Rivera
    • 1
  • Tan Tran
    • 3
  • Adam Mitchell
    • 4
  • Peter Robless
    • 1
  • Alun H. Davies
    • 2
  • George Geroulakos
    • 1
    • 2
    Email author
  1. 1.Vascular Unit, Department of SurgeryEaling Hospital, Uxbridge Road, Southall, Middlesex, UB1 3HW, LondonUK
  2. 2.Department of Vascular SurgeryImperial College School of Medicine, Charing Cross Hospital, LondonUK
  3. 3.Department of RadiologyEaling Hospital, Uxbridge Road, Southall, Middlesex, UB1 3HW, LondonUK
  4. 4.Department of RadiologyCharing Cross Hospital, LondonUK

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