Abstract
The purpose of this prospective study was to evaluate whether stent placement in infrapopliteal arteries is helpful in failed percutaneous transluminal angioplasty (PTA). Infrapopliteal PTA was performed in 70 arteries of 66 patients with chronic critical lower limb ischemia. The group comprised 55 males and 11 females, with an average age of 63.4 (range, 42–82) years. Diabetes mellitus was present in 92.4% of patients. Only the palpable anterior tibial and posterior tibial arteries were evaluated. Stents (Xpert stent; Abbot Vascular, Redwood City, CA, USA) were placed in 16 arteries where PTA was not successful (the failure was defined as residual stenosis >30% after PTA). In 54 arteries simple PTA was performed and was technically successful. Twenty-four nondilated arteries with no significant stenosis served as a comparison group. The 12-month patency rate was evaluated according to a combination of palpation and Doppler ultrasound. In all cases stent placement restored the flow in the artery immediately after unsuccessful PTA. Twelve-month follow-up showed a patency rate of 82% in the PTA group, 78% in the stent group, and 69% in the comparison group. We conclude that stent placement in the case of unsuccessful infrapopliteal PTA changed technical failure to success and restored flow in the dilated artery. At 12-month follow-up the patency rate of infrapopliteal arteries stented for PTA failure did not differ significantly either from nonstented arteries with an optimal PTA result or from a comparison group of nonintervened arteries.
Similar content being viewed by others
References
Söder HK, Manninen HI, Jaakkola P, Matsi PJ, Räsänen HT, Kaukanen E, Loponen P, Soimakallio S (2000) Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia: angiographic and clinical results. J Vasc Interv Radiol 11:1021–1031
Nasr MK, McCarthy RJ, Hardman J, Chalmers A, Horrocks M (2002) The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia. Eur J Vasc Endovasc Surg 23:398–403
Kožnar B (2005) PTA infapopliteálních tepen—porovnání roční klinické úspěšnosti u různých podskupin nemocných. Retrospektivní analýza provedených výkonů, pokus o stanovení faktorů, které ovlivňují záchranu končetiny. Čes Radiol 3:161–170 (in Czech)
Faglia E, Clerici G, Clerissi J, Mantero M, Caminiti M, Quarantiello A, Curci V, Lupattelli T, Morabito A (2007) When is a technically successful peripheral angioplasty effective in preventing above-the-ankle amputation in diabetic patients with critical limb ischaemia? Diabet Med 24(8):823–829
Dorros G, Jaff MR, Dorros AM, Mathiak LM, He T (2001) Tibioperoneal (outflow lesion) angioplasty can be used as primary treatment in 235 patients with critical limb ischemia: five-year follow-up. Circulation 104:2057–2062
Brillu Ch, Picquet J, Villapadierna F, Papon X, L´Hoste P, Jousset Y, Enon B (2001) Percutaneous transluminal angioplasty for management of critical ischemia in arteries below the knee. Ann Vasc Surg 15:175–181
Boyer L, Therre T, Garcier JM, Perez N, Ravel A, Privat C, Viallet JF (2000) Infrapopliteal percutaneous transluminal angioplasty for limb salvage. Acta Radiol 41:73–77
Schillinger M, Exner M, Mlekusch W, Haumer M, Rumpold H, Ahmadi R, Sabeti S, Wagner O, Minar E (2003) Endovascular revascularization below the knee: 6-month results and predictive value of C-reactive protein level. Radiology 227(2):419–425
Lepantalo M, Matzke S (1996) Outcome of unreconstructed chronic critical leg ischaemia. Eur J Vasc Endovasc Surg 11:153–157
Bertele V, Roncaglioni MC, Pangrazzi J, Terzian E, Tognoni EG (1999) Clinical outcome and its predictors in 1560 patients with critical leg ischaemia. Chronic critical leg ischaemia group. Eur J Vasc Endovasc Surg 18:401–410
Atar E, Siegel Y, Avrahami R, Bartal G, Bachar GN, Belenky A (2005) Balloon angioplasty of popliteal and crural arteries in elderly with critical chronic limb ischemia. Eur J Radiol 53(2):287–292
Crew JR, Thuener M (1994) Wound healing: an endpoint for complex peripheral angioplasty. J Endovasc Surg 1:88–91
Siablis D, Karnabatidis D, Katsanos K, Kagadis GC, Kraniotis P, Diamantopoulos A, Tsolakis J (2007) Sirolimus-eluting versus bare stents after suboptimal infrapopliteal angioplasty for critical limb ischemia: enduring 1-year angiographic and clinical benefit. J Endovasc Ther 14(2):241–250
Rand T, Basile A, Cejna M, Fleischmann D, Funovics M, Gschwendtner M, Haumer M, Von Katzler I, Kettenbach J, Lomoschitz F, Luft C, Minar E, Schneider B, Schoder M, Lammer J (2006) PTA versus carbofilm-coated stents in infrapopliteal arteries: pilot study. CardioVasc Interv Radiol 29(1):29–38
Kickuth R, Keo HH, Triller J, Ludwig K, Do DD (2007) Initial clinical experience with the 4-F self-expanding XPERT stent system for infrapopliteal treatment of patients with severe claudication and critical limb ischemia. J Vasc Interv Radiol 18(6):703–708
Krause UJ, Pabst T, Kenn W, Wittenberg G, Hahn D (2004) Time-resolved contrast-enhanced magnetic resonance angiography of the lower extremity. Angiology 55(2):119–125
Wang Y, Truong TN, Yen C, Bilecen D, Watts R, Trost DW, Prince MR (2003) Quantitative evaluation of susceptibility and shielding effects of nitinol, platinum, cobalt-alloy, and stainless steel stents. Magn Reson Med 49(5):972–976
Acknowledgment
This work was supported by IGA MZCR Research Grant NR/7933-4.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Peregrin, J.H., Šmírová, S., Kožnar, B. et al. Self-Expandable Stent Placement in Infrapopliteal Arteries After Unsuccessful Angioplasty Failure: One-Year Follow-up. Cardiovasc Intervent Radiol 31, 860–864 (2008). https://doi.org/10.1007/s00270-007-9292-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-007-9292-2