Clinical outcome following infra-inguinal percutaneous transluminal angioplasty for critical limb ischemia.
OBJECTIVE
The aim of this study was to assess the efficacy and durability of infra-inguinal PTA in patients with CLI, in terms of clinical outcome.


METHODS
Retrospective study of 50 consecutive patients with CLI that were exclusively treated by infra-inguinal PTA.


METHODS
The indications for intervention were rest pain in seven (14%) patients, non-healing ulcers in 27 (54%), and gangrenous lesions in 16 (32%). Thirty-three (66%) of these patients presented with a single arterial lesion, and the remaining 17 (34%) with multilevel arterial lesions. Kaplan-Meier analysis was used to assess survival, patency, limb-salvage rates, and amputation-free survival.


RESULTS
A total of 67 endovascular procedures were performed and 59 (88.1%) of them were considered to be technically successful. The median follow-up period was 12 months (interquartile range: 17 months). The 30-day mortality was 4%, while the cumulative survival rates at 12, 24, and 36 months were 73%, 67%, and 59%, respectively. The cumulative primary patency rates at 12 and 24 months were 63% and 52%, respectively, and remained unchanged thereafter. The estimated secondary patency rate was 72% at 36 months. There was only one below-knee amputation in the patients that were treated exclusively with infra-inguinal PTA. The cumulative amputation-free survival at the same period was estimated at 60%.


CONCLUSIONS
Infra-inguinal PTA had a good early and late outcome in this series of patients with a limited life expectancy. These results are comparable to historical results of surgical revascularization in the treatment of CLI. There is need for a randomized study to determine the primary optimal interventional approach for patients with CLI.
Matsagas
Miltiadis I
MI
Vascular Unit, Department of Surgery, Ealing Hospital, Uxbridge Road, Southall, Middlesex, UB1 3HW, London, UK.
Rivera
Marco A
MA
Tran
Tan
T
Mitchell
Adam
A
Robless
Peter
P
Davies
Alun H
AH
Geroulakos
George
G
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery*; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007866:Leg / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery*; D008131:London; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology