Transluminal angioplasty of isolated crural arterial lesions in diabetics with critical limb ischemia.
BACKGROUND
We investigated the long-term clinical results of transluminal angioplasty of isolated infrapopliteal arteries in diabetic patients with severe ischaemic foot lesions and the influence of different parameters on primary success, the long-term outcome and the survival rate.


METHODS
Between January 2001 and May 2004 we performed 50 transluminal angioplasties in 52 (10 female, 42 male, mean age 69.3 years) diabetics with isolated lesions of crural arteries (tibio-peroneal trunk 41, anterior tibial 13, posterior tibial 5, peroneal artery 14) and limb threatening ischaemia (rest pain 12, tissue loss 40). In two patients the dilatation could not be performed due to vessel perforation and impossibility to catheter localization. The morphological classification of infrapopliteal lesions was determined according to guidelines provided by TransAtlantic Inter-Society Consensus (TASC) (17 type A, 16 type B, 13 type C, 4 type D).


RESULTS
Initial technical success after angioplasty of crural arteries could be obtained in 96%. Kaplan-Meier analysis showed a cumulative limb salvage of 92%, 85% and 68,9% after 6 months, one and two years, respectively. Patients falling in TASC group C had significantly higher risk of amputation. Overall survival at I year was calculated at 85% and at 2 years at 65%.


CONCLUSIONS
Our results suggest that depending on the extent of lesions transluminal angioplasty of infrapopliteal artery stenoses and occlusions is considered as an effective and save therapy modality to avoid limb loss in diabetics with critical ischemia.
Sigala
F
F
Kplus Vascular Centre Haan, Department of Vascular and Endovascular Surgery, St. Josef Hospital Haan GmbH, Haan, Germany. rizzo@k-plus.de
Menenakos
Ch
Ch
Sigalas
P
P
Baunach
Ch
Ch
Langer
St
S
Papalambros
E
E
Hepp
W
W
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality* / Q000601:surgery*; D017719:Diabetic Foot / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000401:mortality* / Q000601:surgery*; D007866:Leg / Q000098:blood supply / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome