Complex endovascular treatment for critical limb ischemia in poor surgical candidates: a pilot study.
OBJECTIVE
To evaluate the effectiveness of complex endovascular treatment for limb salvage in patients with critical limb ischemia.


METHODS
In a prospective study, 23 patients (13 men; mean age 70 +/- 11 years, range 44-87) with ischemic ulceration or gangrene of 25 lower limbs were enrolled at 4 sites to evaluate treatment with excimer laser recanalization followed by balloon angioplasty with optional stenting in the superficial femoral, popliteal, and/or tibial arteries.


RESULTS
Multiple lesions (mean 3.1, range 1-8) were treated in most cases. Reduction of stenosis/occlusion to <50% was achieved in 22 (88%) limbs. Individual cases of vessel perforation, inability to cross the lesion, and excessive residual stenosis accounted for the 3 failures. Over a 6-month period, 4 patients died of cardiac comorbidity and 1 was lost to follow-up. Adverse events included 4 minor and 2 below-knee amputations, 4 secondary angioplasties, and 4 femorodistal bypasses. The mean wound area reduction was 70% at 3 months, increasing to 89% at 6 months. According to life table analysis, the limb salvage rate was 90% with bypass and 69% without in the successfully treated patients (corresponding intention-to-treat rates were 79% and 61%).


CONCLUSIONS
Complex endovascular treatment combining laser debulking and angioplasty/stenting offers an alternative for patients with critical limb ischemia who lack good surgical options.
Gray
Bruce H
BH
The Cleveland Clinic Foundation, Cleveland, OH, USA. bhgray@ghs.org
Laird
John R
JR
Ansel
Gary M
GM
Shuck
John W
JW
D000328:Adult; D000368:Aged; D017222:Angioplasty, Balloon, Laser-Assisted; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010865:Pilot Projects; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D011859:Radiography; D015607:Stents; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery