Subintimal angioplasty for below-the-ankle arterial occlusions in diabetic patients with chronic critical limb ischemia.
OBJECTIVE
To assess the feasibility and efficacy of subintimal angioplasty (SA) in the treatment of below-the-ankle arterial occlusion in diabetic patients with chronic critical limb ischemia (CLI).


METHODS
SA was applied in 37 diabetic patients (24 men; mean age 70.9+/-8.5 years, range 52-88) with chronic CLI and occlusive disease of the dorsalis pedis artery (DPA) and/or plantar artery (PA) but were poor candidates for intraluminal angioplasty or bypass surgery. Tissue loss was present in 31 (54.4%) of 57 afflicted limbs, and rest pain was reported in 51 (89.5%) limbs. SA was performed to create continuous arterial flow to the foot for limb salvage. The clinical symptoms, DPA or PA pulse volume scores, and ankle-brachial index (ABI) were compared before and after SA. Wound healing, amputation, and restenosis of target vessels were also evaluated at follow-up. Kaplan-Meier curves were constructed to evaluate limb salvage, survival, and freedom from amputation.


RESULTS
Below-the-ankle SA was performed successfully in 55 (83.3%) of 66 arteries in 57 limbs. Median pulse volume scores and ABIs were 0.33+/-0.55 and 0.31+/-0.19 before SA and 2.04+/-1.05 and 0.80+/-0.14 after SA, respectively (p<0.0001 for both). The 30-day mortality was 2.7%. Median follow-up was 9.1+/-6.1 months (range 1-18). Major complications occurred in 1 (2.7%) patient and minor complications in 3 (8.1%). Twelve months after SA, Kaplan-Meier analysis showed that the limb salvage rate was 94.6%, the freedom from amputation was 89.2%, and the survival rate was 97.3%.


CONCLUSIONS
SA of the dorsalis pedis artery and/or plantar artery is a useful technique for lower limb salvage in diabetic patients with chronic CLI who are not candidates for bypass surgery.
Department of Radiology, The Sixth Affiliated People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
Yue-Qi
YQ
Zhu
Jun-Gong
JG
Zhao
Fang
F
Liu
Jian-Bo
JB
Wang
Ying-Sheng
YS
Cheng
Ming-Hua
MH
Li
Jue
J
Wang
Jie
J
Li
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000401:mortality; D000842:Ankle / Q000098:blood supply*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D002908:Chronic Disease; D003251:Constriction, Pathologic; D016638:Critical Illness; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014945:Wound Healing