What's next after optimal infrapopliteal angioplasty? Clinical and ultrasonographic results of a prospective single-center study.
OBJECTIVE
To evaluate arterial patency and factors influencing outcomes after successful tibial artery angioplasty in patients with critical limb ischemia (CLI).


METHODS
From January 2005 to August 2007, a prospective single-center study was conducted involving 80 CLI patients (56 men; mean age 71.7+/-8.8 years) who underwent successful tibial artery angioplasty (<30% residual stenosis) in 87 limbs. Eighty (92%) limbs showed ischemic ulcers or gangrene at baseline. In two thirds, a more proximal lesion was treated, and a secondary stent was implanted in 14 (16%). Follow-up included clinical examination for wound healing (WH), limb salvage (LS), and duplex-documented target vessel patency or restenosis at discharge and at 1, 3, 6, 9, 12, 18, and then every 6 months. Patency rates, WH, and LS were assessed with the Kaplan-Meier method, and factors influencing these outcomes were analyzed using Cox proportional hazards models.


RESULTS
Mean follow-up was 10.9 months (range 2 days - 29 months). At 12 months, the primary and assisted primary patency rates were 37.9% and 71.2%, respectively. Restenosis was significantly correlated with smoking (HR 3.58, 95% CI 1.15 to 11.18; p = 0.02), infected ulcers (HR 2.04, 95% CI 1.02 to 4.09; p = 0.04), and posterior tibial artery angioplasty (HR 3.76, 95% CI 1.59 to 8.87; p = 0.003). Rates of LS and WH at 12 months were 92.7% and 74.9%, respectively. Peroneal angioplasty was significantly correlated with WH (HR 1.83, 95% CI 1.04 to 3.25; p = 0.03), and wound healing increased with classes of age (HR 1.60, 95% CI 1.07 to 2.39; p = 0.02).


CONCLUSIONS
One-year restenosis after optimal tibial artery angioplasty is significant and positively correlated with smoking, infection of trophic lesions, and posterior tibial artery angioplasty. Close ultrasound surveillance provides good limb salvage after optimal infrapopliteal angioplasty in patients with CLI.
Department of Vascular Surgery, Alma Mater Studiorum, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. mauro.gargiulo2@unibo.it
Mauro
M
Gargiulo
Filippo
F
Maioli
Tanja
T
Ceccacci
Antonio Maria
AM
Morselli-Labate
Gianluca
G
Faggioli
Antonio
A
Freyrie
Federica
F
Giovanetti
Gabriele
G
Testi
Natascia
N
Muccini
Andrea
A
Stella
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001363:Awards and Prizes; D003251:Constriction, Pathologic; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016909:Tibial Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014945:Wound Healing; D014946:Wound Infection / Q000150:complications