title: Infrapopliteal angioplasty with a long over-the-wire (OTW) balloon in the treatment of severe limb ischemia in diabetic patients: a retrospective study.
abstract: BACKGROUND
  The use of short balloons in the treatment of infrapopliteal arterial occlusive disease in diabetic patients often has a poor clinical outcome.
  
  
  OBJECTIVE
  To retrospectively evaluate the safety and efficacy of a long over-the-wire (OTW) balloon as a primary percutaneous transluminal angioplasty (PTA) treatment for diabetic infrapopliteal severe limb ischemia.
  
  
  METHODS
  Infrapopliteal PTA with a long OTW balloon was performed between April 2007 and March 2008 in 34 patients (53 limbs), including a total of 119 lesions. Patient age was 71.8+/-7.4 years. All patients had limb ischemic symptoms. Angiography was retrospectively analyzed, and every lesion categorized and classified according to its length and severity. The mean follow-up period was 7.4+/-2.6 months. Lower-limb magnetic resonance angiography (MRA) was performed every 3 months during follow-up, and clinical data were collected.
  
  
  RESULTS
  Altogether, 92% of patients were successfully treated. Ankle-brachial index (ABI) and transcutaneous oxygen tension (TcPO2) improved from 0.50+/-0.18 and 18.85+/-12.08 mmHg, respectively, before the procedure to 0.81+/-0.12 and 39.85+/-12.67 mmHg, respectively, after the procedure. At the end of follow-up, 29 patients had maintained a stable outcome. Five patients had symptom recurrence, and three of them underwent a second PTA. Two major amputations and four minor amputations were performed, with a 94% limb salvage rate and 59% patency rate.
  
  
  CONCLUSIONS
  Infrapopliteal PTA with a long OTW balloon was feasible, with encouraging midterm outcome, in the treatment of severe limb ischemia in diabetic patients in this single-center case series. Further research is warranted to evaluate long-term outcome.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Jue
authors.initials: J
authors.lastname: Wang
authors.forename: Yue-Qi
authors.initials: YQ
authors.lastname: Zhu
authors.forename: Jun-Gong
authors.initials: JG
authors.lastname: Zhao
authors.forename: Jian-Bo
authors.initials: JB
authors.lastname: Wang
authors.forename: Ying-Sheng
authors.initials: YS
authors.lastname: Cheng
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Li
authors.forename: Wu
authors.initials: W
authors.lastname: Wang
authors.forename: Pei-Lei
authors.initials: PL
authors.lastname: Zhang
authors.forename: Zhuo-Ying
authors.initials: ZY
authors.lastname: Du