Clinical Outcome of Infrapopliteal Angioplasty for Treatment of Chronic Lower Limb Ischemia

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.