DOI QR코드

DOI QR Code

Clinical Outcomes of Infrapopliteal Angioplasty in Patients With Critical Limb Ischemia

  • Ryu, Hyeon-Min (Gumi CHA Medical Center, CHA University) ;
  • Kim, Jung-Sun (Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Ko, Young-Guk (Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Hong, Myeong-Ki (Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Jang, Yang-Soo (Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Choi, Dong-Hoon (Severance Cardiovascular Hospital, Yonsei University College of Medicine)
  • Published : 2012.04.30

Abstract

Background and Objectives: With recent advances in equipment and techniques, infrapopliteal angioplasty has shown results that are comparable to those of surgical bypass in patients with critical limb ischemia (CLI). In this study, we evaluated the efficacy and the feasibility of infrapopliteal angioplasty in patients with CLI. Subjects and Methods: Between March 2002 and May 2008, infrapopliteal angioplasty was performed on 118 limbs of 101 patients (79 males; mean age 66 years) with CLI (Rutherford category 4, 5 or 6). Freedom from reintervention, limb salvage, and overall survival were analyzed. Results: The median follow-up duration was 30 months. Initial technical and clinical success rates were 69.5% and 83.1%, respectively. No major complication requiring surgical intervention developed after angioplasty. Among 82 limbs with initial technical success, the rate of freedom from any reintervention at 2 years was 70.7% and that from limb salvage was 97.6%. Young age and Rutherford category 6 at initial presentation were independent predictors associated with poor 2 year primary patency in these patients with CLI. Overall survival at 1 year was 86.4% and that at 2 years 76.3%. A history of cerebrovascular accident was an independent predictor associated with poor 2 year survival in these patients. Conclusion: Infrapopliteal angioplasty as a primary choice of treatment in CLI patients showed favorable clinical outcomes and feasibility.

Keywords

References

  1. Blair JM, Gewertz BL, Moosa H, Lu CT, Zarins CK. Percutaneous transluminal angioplasty versus surgery for limb-threatening ischemia. J Vasc Surg 1989;9:698-703. https://doi.org/10.1016/S0741-5214(89)70042-2
  2. Treiman GS, Treiman RL, Ichikawa L, van Allan R. Should percutaneous transluminal angioplasty be recommended for treatment of infrageniculate popliteal artery or tibioperoneal trunk stenosis? J Vasc Surg 1995;22:457-63. https://doi.org/10.1016/S0741-5214(95)70015-3
  3. Parsons RE, Suggs WD, Lee JJ, Sanchez LA, Lyon RT, Veith FJ. Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: do the results justify an attempt before bypass grafting? J Vasc Surg 1998;28:1066-71. https://doi.org/10.1016/S0741-5214(98)70033-3
  4. Clair DG, Dayal R, Faries PL, et al. Tibial angioplasty as an alternative strategy in patients with limb-threatening ischemia. Ann Vasc Surg 2005;19:63-8. https://doi.org/10.1007/s10016-004-0136-0
  5. Soder HK, Manninen HI, Jaakkola P, et al. Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia: angiographic and clinical results. J Vasc Interv Radiol 2000;11:1021-31. https://doi.org/10.1016/S1051-0443(07)61332-3
  6. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000;31(1 Pt 2):S1-296. https://doi.org/10.1016/S0741-5214(00)81002-2
  7. Schwarten DE. Clinical and anatomical considerations for nonoperative therapy in tibial disease and the results of angioplasty. Circulation 1991;83(2 Suppl):I86-90.
  8. Hanna GP, Fujise K, Kjellgren O, et al. Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: importance of aggressive interventional approach and role of transcutaneous oximetry. J Am Coll Cardiol 1997;30:664-9. https://doi.org/10.1016/S0735-1097(97)00216-7
  9. Siablis D, Kraniotis P, Karnabatidis D, Kagadis GC, Katsanos K, Tsolakis J. Sirolimus-eluting versus bare stents for bailout after suboptimal infrapopliteal angioplasty for critical limb ischemia: 6-month angiographic results from a nonrandomized prospective single-center study. J Endovasc Ther 2005;12:685-95. https://doi.org/10.1583/05-1620MR.1
  10. Tsetis D, Belli AM. The role of infrapopliteal angioplasty. Br J Radiol 2004;77:1007-15. https://doi.org/10.1259/bjr/97382129
  11. Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997;26:517-38. https://doi.org/10.1016/S0741-5214(97)70045-4
  12. Olin JW. Thromboangiitis obliterans (Buerger's disease). In: Rutherford RB, editor. Rutherford's Vascular Surgery. 6th ed. Philadelphia: Elsevier Saunders;2005. p.404-19.
  13. Adam DJ, Beard JD, Cleveland T, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 2005;366:1925-34. https://doi.org/10.1016/S0140-6736(05)67704-5
  14. Feiring AJ, Wesolowski AA, Lade S. Primary stent-supported angioplasty for treatment of below-knee critical limb ischemia and severe claudication: early and one-year outcomes. J Am Coll Cardiol 2004;44:2307-14. https://doi.org/10.1016/j.jacc.2004.09.037
  15. Krankenberg H, Sorge I, Zeller T, Tubler T. Percutaneous transluminal angioplasty of infrapopliteal arteries in patients with intermittent claudication: acute and one-year results. Catheter Cardiovasc Interv 2005;64:12-7. https://doi.org/10.1002/ccd.20237
  16. Romiti M, Albers M, Brochado-Neto FC, Durazzo AE, Pereira CA, De Luccia N. Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg 2008;47:975-81. https://doi.org/10.1016/j.jvs.2008.01.005
  17. Rastogi S, Stavropoulos SW. Infrapopliteal angioplasty. Tech Vasc Interv Radiol 2004;7:33-9. https://doi.org/10.1053/j.tvir.2004.01.001
  18. Criqui MH, Langer RD, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992;326:381-6. https://doi.org/10.1056/NEJM199202063260605
  19. Golomb BA, Dang TT, Criqui MH. Peripheral arterial disease: morbidity and mortality implications. Circulation 2006;114:688-99. https://doi.org/10.1161/CIRCULATIONAHA.105.593442
  20. Balmer H, Mahler F, Do DD, Triller J, Baumgartner I. Balloon angioplasty in chronic critical limb ischemia: factors affecting clinical and angiographic outcome. J Endovasc Ther 2002;9:403-10. https://doi.org/10.1583/1545-1550(2002)009<0403:BAICCL>2.0.CO;2
  21. Bailey CM, Saha S, Magee TR, Galland RB. A 1 year prospective study of management and outcome of patients presenting with critical lower limb ischaemia. Eur J Vasc Endovasc Surg 2003;25:131-4. https://doi.org/10.1053/ejvs.2002.1817
  22. Kudo T, Chandra FA, Ahn SS. The effectiveness of percutaneous transluminal angioplasty for the treatment of critical limb ischemia: a 10-year experience. J Vasc Surg 2005;41:423-35. https://doi.org/10.1016/j.jvs.2004.11.041
  23. Lofberg AM, Lorelius LE, Karacagil S, Westman B, Almgren B, Berqgvist D. The use of below-knee percutaneous transluminal angioplasty in arterial occlusive disease causing chronic critical limb ischemia. Cardiovasc Intervent Radiol 1996;19:317-22. https://doi.org/10.1007/BF02570182

Cited by

  1. Prognosis of Critical Limb Ischemia in Hemodialysis Patients After Isolated Infrapopliteal Balloon Angioplasty: Results From the Japan Below-the-Knee Artery Treatment (J-BEAT) Registry vol.20, pp.1, 2012, https://doi.org/10.1583/11-3782.1
  2. Systematic Review and Meta-Analysis of Balloon Angioplasty Versus Primary Stenting in the Infrapopliteal Disease vol.48, pp.1, 2014, https://doi.org/10.1177/1538574413510626
  3. Cutting Balloon Angioplasty in the Treatment of Short Infrapopliteal Bifurcation Disease vol.22, pp.4, 2012, https://doi.org/10.1177/1526602815594250
  4. Percutaneous Transluminal Angioplasty in Patients With Infrapopliteal Arterial Disease : Systematic Review and Meta-Analysis vol.9, pp.5, 2012, https://doi.org/10.1161/circinterventions.115.003468
  5. Impact of uncontrolled hypertension on 12-month clinical outcomes following below-the-knee arteries (BTK) interventions in patients with critical limb ischemia vol.22, pp.None, 2016, https://doi.org/10.1186/s40885-016-0044-y
  6. Comparative study of outcomes between single-vessel versus multiple-vessel infrapopliteal angioplasties in patients with chronic limb-threatening ischemia vol.7, pp.2, 2012, https://doi.org/10.4103/ijves.ijves_64_19
  7. Attempting mini-invasiveness in the critically ill patient. The endovascular first act: the below-the-knee challenges vol.27, pp.4, 2012, https://doi.org/10.23736/s1824-4777.21.01503-5
  8. Cord Lining Mesenchymal Stem Cells Have a Modest Positive Effect on Angiogenesis in Hindlimb Ischemia vol.8, pp.None, 2012, https://doi.org/10.3389/fcell.2020.596170