Primary Infrainguinal Subintimal Angioplasty in Diabetic Patients

• Published in: Cardiovascular and interventional radiology 2008-07, Vol.31 (4), p.713-722
• Main Authors: Bargellini, Irene, Petruzzi, Pasquale, Scatena, Alessia, Cioni, Roberto, Cicorelli, Antonio, Vignali, Claudio, Rizzo, Loredana, Piaggesi, Alberto, Bartolozzi, Carlo
• Format: Article
• Language: English
• Subjects: Aged; ANEMIAS; Angiography - methods; Angioplasty - adverse effects; Angioplasty - methods; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - surgery; BIOLOGICAL RECOVERY; BODY; Cardiology; CARDIOVASCULAR DISEASES; Clinical Investigation; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetic Angiopathies - diagnostic imaging; Diabetic Angiopathies - therapy; DISEASES; Female; Follow-Up Studies; HEALING; HEMIC DISEASES; Humans; Imaging; Inguinal Canal - blood supply; ISCHEMIA; Limb Salvage - methods; LIMBS; Male; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; PATHOLOGICAL CHANGES; PATIENTS; Peripheral Vascular Diseases - diagnostic imaging; Peripheral Vascular Diseases - surgery; Prospective Studies; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Risk Assessment; Sensitivity and Specificity; SYMPTOMS; Treatment Outcome; Tunica Intima - pathology; Tunica Intima - surgery; ULCERS; Ultrasound; VASCULAR DISEASES; Vascular Patency - physiology
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-008-9366-9

The aim of this study was to prospectively evaluate technical and clinical results of infrainguinal subintimal angioplasty in a series of diabetic patients with limb-threatening ischemia. From July 2003 to December 2007, 60 consecutive diabetic patients (M/F = 41/19; mean age, 69.4 ± 9.4 years) with Fontaine stage IV critical limb ischemia, not suitable for surgical recanalization, underwent primary infrainguinal subintimal angioplasty. The technical success, perioperative morbidity and mortality, and clinical success (defined by ulcer healing) were evaluated. Kaplan–Meier life-table analysis was obtained for cumulative clinical success, limb salvage, and survival rates. The procedure was technically successful in 55 of 60 (91.7%) patients; in 5 cases we were not able to achieve a reentry. Periprocedural mortality was 5% (3 patients); three patients (5%) required major amputation periprocedurally. Mean follow-up was 23 months (range, 0–48 months). On an intention-to-treat basis, the limb salvage rate was 93.3% (56/60 patients); ulcer healing was observed in 45 of 60 (75%) patients and it was significantly ( p