Limb Salvage after Infrapopliteal Angioplasty for Critical Limb Ischemia in Surgically High-Risk Patients in Iran

• Published in: Journal of pioneering medical sciences 2011-10, Vol.1 (3), p.85-88
• Main Authors: Mohammad Ali Ostovan, Tavassoli, Maryam, Ghofraniha, Afshin, Mirmohammad Hosseinali Sharifian Davaei, Kojuri, Javad
• Format: Article
• Language: English
• ISSN: 2309-7981; 2309-7981

Introduction: Surgical bypass for the treatment of lower extremity peripheral arterial disease is a suboptimal option in high-risk surgical patients or patients with limited life expectancy. Percutaneous transluminal angioplasty (PTA) is an alternative in such patients; however, the results of this approach have not been well-studied in our region. This study evaluated the results of infrapopliteal percutaneous transluminal angioplasty and/or stenting for critical limb ischemia (CLI) due to peripheral arterial disease of lower limbs in surgically high-risk patients. Methods: We conducted a retrospective study in four medical centers in Iran, from May 2006 to September 2009. Patients with CLI (Rutherford category 4-6), multiple two-vessel lesions, ankle-brachial index (ABI) of less than 0.05, high surgical risk category, and a follow-up of > 1 year after percutaneous transluminal angioplasty were included. Patients with restenosis of graft lesions, a life expectancy of less than 1 year, or those who were thienopyridine intolerant were excluded. "Limb salvage" was defined as a reduction in stenosis or occlusion to less than 30%. The primary endpoint was limb salvage rate. Survival and patency were evaluated with the Kaplan-Meier method. Results: Sixty patients met the inclusion criteria. Mean age was 60.5±8.4 years (men 73.3%, diabetes mellitus 83.3%, current smoker 33.3%, hypertension 70%) and baseline ABI was 0.51±0.08. Anterior tibial artery (47%) was the most frequently involved blood vessel. A total of 22 stents and 122 balloon angioplasties were used in 98 limbs. "Limb salvage" was achieved in 58 (96.6%) patients immediately after the procedure. One-year salvage rate was 88.3%. Complete ulcer healing was achieved in 64.3% patients, and partial healing was obtained in 26.4%. Only one major procedure-related complication was reported; perforation with post-operative compartment syndrome. Major arterial access site complications (n=3, 5%) included two hematomas and a pseudoaneurysm. One-year survival rate was 96.6%. One-year major amputation rate was 11.7%. Conclusions: Infrapopliteal angioplasty alone or with stenting is a valuable treatment option for the prevention of amputations in patients with CLI for whom surgical bypass is not an option and in whom the risk of amputation is high.