Angiographic patency and clinical outcome after balloon-angioplasty for extensive infrapopliteal arterial disease.
OBJECTIVE
Restenosis-rate after balloon-angioplasty of long segment tibial arterial disease is largely unknown. We investigated the restenosis-rates angiographically in patients with critical limb ischemia (CLI) due to extensive infrapopliteal lesions.


METHODS
Angioplasty for infrapopliteal lesions exclusively ≥80 mm in length was performed using dedicated 80-120 mm long low-profile balloons. Follow-up included angiography at 3 months and clinical assessment at 3 and 15 months.


RESULTS
Angioplasty was performed in 77 infrapopliteal arteries of 62 limbs of 58 CLI patients with a Rutherford class 4 in 16 (25.8%) limbs and Rutherford class 5 in 46 limbs (74.2%). Average lesion length was 18.4 cm. Treated arteries were stenosed in 35.1% and occluded in 64.9%. After 3 months, a clinical improvement (marked reduction of ulcer-size or restpain) was seen in 47 (75.8%) limbs, 14 (22.6%) limbs were clinically unchanged and 1 (1.6%) limb showed a clinical deterioration. Angiography at 3 months showed no significant restenosis in 24 of 77 (31.2%) treated arteries, a restenosis ≥50% in 24 (31.2%) arteries and a reocclusion in 29 of 77 (37.6%). At 15 months death rate was 10.5%. After repeat angioplasty in case of restenosis cumulative clinical results at 15 months were minor amputations in 8.1%, no major amputations resulting in a limb-salvage rate of 100% with no patient requiring bypass surgery.


CONCLUSIONS
Restenosis-rate after angioplasty of extensive infrapopliteal arterial disease is high and occurs early after treatment. Despite this the clinical results are excellent, especially given the length of the arterial segments diseased.
Department of Internal Medicine I, Angiology, Cardiology, Park Hospital Leipzig, Leipzig, Germany. andrej.schmidt@gmx.de
Andrej
A
Schmidt
Matthias
M
Ulrich
Bert
B
Winkler
Christina
C
Klaeffling
Yvonne
Y
Bausback
Sven
S
Bräunlich
Spiridon
S
Botsios
Hans-Joachim
HJ
Kruse
Ramon L
RL
Varcoe
Steven
S
Kum
Dierk
D
Scheinert
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003251:Constriction, Pathologic; D016638:Critical Illness; D005260:Female; D005858:Germany; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011859:Radiography; D012008:Recurrence; D012042:Registries; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency