Limb salvage procedure in occlusion of the infrapopliteal arteries.
OBJECTIVE
Limb salvage is a procedure for treatment of the causes of ischemia in the peripheral arteries of the lower limbs. This procedure consists of percutaneous transluminal angioplasty (PTA) of arteries of the infrapopliteal segment in the lower limbs, endovascular stents implantation and selective intraarterial thrombolytic therapy. The main PTA principle is balloon dilatation of a blood vessel and increasing blood flow in this zone. The aim of this study was to show the validity and benefits of applying this procedure in pathologically corrupted arteries of the infrapopliteal segment.


METHODS
A prospective study included 30 patients: 15 with PTA dilatations, 13 with stents implantations and five with thrombolytic therapy. The follow-up pertiod was: immediately after the procedure, a month later, and six months later.


RESULTS
Of the 15 patients with balloon dilatation, three still suffered from artery stenosis, and they additionally underwent stents implantation. These three patients were in the group of 13 patients who had underwent stent implantation. The last group consisted of five patients with thrombolytic therapy (urokinase, streptokinase, rt-PA--recombinant tissue plasminogen activator). Restenosis appeared only in the three patients from the first group (PTA) immediately after the intervention. A month later, there was no restenosis or ischemia of the limbs. After six months, restenosis appeared in three patients from the first group (PTA), in one patient from the second group (stent), and in two patients from the third group (thrombolytic therapy). The best results were shown by the stent implantation method (successful in 92.3% of the cases), PTA (75%), and thrombolytic therapy (60%).


CONCLUSIONS
On the basis of the obtained results it can be concluded that the limb salvage method in case of occluded arteries of infrapopliteal segment is fully justified, especially the stent implantation method being successful in 92.3% of the patients within a six month-period of time, which is a relevant proof of its efficiency.
Mijailović
Milan
M
Clinical Center Kragujevac, Roentgen Diagnostic Center Kragujevac, Serbia. mmilan@ptt.yu
Lukić
Snezana
S
D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D012008:Recurrence; D015607:Stents; D015912:Thrombolytic Therapy