Prospective Trial of Infrapopliteal Artery Balloon Angioplasty for Critical Limb Ischemia: Angiographic and Clinical Results

• Published in: Journal of vascular and interventional radiology Vol. 11; no. 8; pp. 1021 - 1031
• Main Authors: Söder, Heini K., Manninen, Hannu I., Jaakkola, Pekka, Matsi, Pekka J., Räsänen, Heikki T., Kaukanen, Erkki, Loponen, Pertti, Soimakallio, Seppo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2000
• Subjects: Adult; Aged; Aged, 80 and over; Angiography; Angioplasty, Balloon; Angioplasty, infrapopliteal; Arterial Occlusive Diseases - therapy; Chi-Square Distribution; Extremities, blood supply; Female; Humans; Ischemia - therapy; Leg - blood supply; Logistic Models; Male; Middle Aged; Popliteal Artery - diagnostic imaging; Popliteal Artery - surgery; Proportional Hazards Models; Prospective Studies; Statistics, Nonparametric; Treatment Outcome; Vascular Patency; Extremities, blood supply; Angioplasty, infrapopliteal; DSA; PTA
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/S1051-0443(07)61332-3

To evaluate the safety and efficacy of infrapopliteal percutaneous transluminal angioplasty (PTA) as a primary treatment of chronic critical limb ischemia in a prospective trial. Infrapopliteal PTA was performed on 72 limbs of 60 patients (mean age, 72 y; range, 38–92 y) and patients were followed for 12–24 months. The primary angiographic success rate for the stenoses was 84% (102 of 121) and that for the occlusions was 61% (41 of 67) with corresponding restenosis rates of 32% and 52% at follow-up angiography performed a mean of 10 months after primary PTA. The rate of major complications was 2.8% (access site pseudoaneurysms in two patients). The primary clinical success was 63% (45 of 72). A 48% cumulative primary patency rate, a 56% secondary patency rate, and a 80% cumulative limb salvage rate were registered at 18 months, as determined with use of Kaplan-Meier analysis. Lack of angiographic improvement at the site of the most severe ischemia and renal insufficiency (serum creatinine level > 130 mmol/L) were independent predictors of poorer long-term clinical results, as determined with use of Cox multiple regression analysis. Infrapopliteal PTA is a feasible primary treatment of chronic critical limb ischemia with moderate primary angiographic and clinical success, a low complication rate, and a cumulative limb salvage rate comparable with surgical techniques.