Role of duplex-guided infragenicular angioplasty in saving limbs

• Published in: Journal of the Arab Society for Medical Research Vol. 17; no. 2; pp. 188 - 192
• Main Authors: Elimam, Sameh, Shereif, Hala
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer India Pvt. Ltd 01.07.2022; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Angioplasty; critical limb ischemia; duplex-guided angioplasty; limb salvage; duplex-guided angioplasty; limb salvage; critical limb ischemia
• ISSN: 1687-4293; 2090-3286
• DOI: 10.4103/jasmr.jasmr_11_22

Background/aim Critical limb ischemia (CLI) is known as ischemic rest pain at rest or tissue loss with peripheral arterial disease. Endovascular intervention has many advantages than surgical bypasses and it is used frequently with fragile patients, at the same time, it has many adverse effects for both surgeon and patient such as radiation effect for both and renal-induced nephropathy for the patient. Worldwide duplex-guided infragenicular angioplasty is a new method that has been started to emerge and to be a common technique in such patients, That is why the present study aims to assess the feasibility and efficacy of duplex-guided infragenicular angioplasty to save limbs and to detect if it is applicable or not. Patients and methods Twenty CLI patients were admitted to the vascular unit from 2015 to 2017 in Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt. We included patients with good femoral pulse and significant infragenicular lesions. We excluded those with proximal outflow lesions and with acute embolic or thrombotic insults. Percutanous transluminal angioplasty was done to all the patients through ipsilateral femoral access by using 0.014 and 0.018 wires 4 F catheters and low-profile balloons, then we followed them clinically and with duplex ultrasound at 1, 3, 6, and 12 months with calculating the hemodynamic studies. Results The present study enrolled 20 patients, six (30%) of them are females and 14 (70%) males, with mean age of 59.2. The clinical history of smokers, cardiac, diabetics, renal, and hypertensive were 65, 60, 50, 85, and 80%, respectively. Technical success was 90%. Groin hematoma, distal thrombosis, and vessel perforation were technical complications, with 5% for each. Optimal procedural success was achieved in 70%, of suboptimal in 20%, and then we failed in 10%. Rest paint completely disappeared from 75% of patients. Sixteen limbs were saved postintervention, Kaplan-Meier curve showed 70% survival rate at 6 months, while at 9 months, the drop occurred to be 28%, which was still to be the percent at 12 months. Conclusion Modern duplex ultrasound can be used to map the arterial disease and to show guide wires, sheaths, balloons, and stents for the treatment of infragenicular arterial lesions. Also, it seems to be safe, easy and effective technique, a bedside procedure, and cost-effective as well. It has a crucial role in saving limbs for CLI patients.