title: Outcomes following infrapopliteal angioplasty for critical limb ischemia.
abstract: OBJECTIVE
  Infrapopliteal angioplasty (percutaneous transluminal angioplasty [PTA]) is routinely used to treat critical limb ischemia (CLI) despite limited data on long-term outcomes.
  
  
  METHODS
  We reviewed all patients undergoing infrapopliteal PTA for CLI from 2004 to 2012 stratified by TransAtlantic Inter-Society Consensus (TASC) class. Outcomes included restenosis, primary patency, reintervention (w/PTA or bypass), amputation, procedural complications, wound healing, and survival.
  
  
  RESULTS
  Infrapopliteal PTA (stenting 14%, multilevel intervention 50%) was performed in 459 limbs of 413 patients (59% male) with a technical success of 93% and perioperative complications in 11%. TASC class was 16% A, 22% B, 27% C, and 34% D. Multilevel interventions were performed in 50% of limbs and were evenly distributed among all TASC classes. All technical failures were TASC D lesions. Mean follow-up was 15 months; 5-year survival was 49%. One- and 5-year primary patency was 57% and 38% and limb salvage was 84% and 81%, respectively. Restenosis was associated with TASC C (hazard ratio [HR], 2.2; 95% CI, 1.2-3.9; P = .010) and TASC D (HR, 2.4; 95% CI, 1.3-4.4; P = .004) lesions. Amputation rates were higher in patients who were not candidates for bypass (HR, 4.4; 95% CI, 2.6-7.5; P < .001) and with TASC D lesions (HR, 3.8; 95% CI, 1.1-12.5; P = .03). Unsuitability for bypass was also predictive of repeat PTA (HR, 1.8; 95% CI, 1.0-3.4; P = .047). Postoperative clopidogrel use was associated with lower rates of any revascularization (HR, 0.46; 95% CI, 0.25-0.83; P = .011).
  
  
  CONCLUSIONS
  Infrapopliteal PTA is effective primary therapy for TASC A, B, and C lesions. Surgical bypass should be offered to patients with TASC D disease who are suitable candidates. Multilevel intervention does not adversely affect outcome.
authors: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass 02215, USA.
authors: Ruby C
authors: RC
authors: Lo
authors: Jeremy
authors: J
authors: Darling
authors: Rodney P
authors: RP
authors: Bensley
authors: Kristina A
authors: KA
authors: Giles
authors: Suzanne E
authors: SE
authors: Dahlberg
authors: Allen D
authors: AD
authors: Hamdan
authors: Mark
authors: M
authors: Wyers
authors: Marc L
authors: ML
authors: Schermerhorn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
references: Ann Surg. 2010 Nov;252(5):765-73
references: 21037432
references: J Vasc Surg. 2009 Oct;50(4):799-805.e4
references: 19786239
references: J Vasc Surg. 2008 May;47(5):975-981
references: 18372148
references: J Vasc Surg. 2011 Oct;54(4):1021-1031.e1
references: 21880457
references: J Vasc Surg. 2005 Mar;41(3):423-35; discussion 435
references: 15838475
references: J Vasc Surg. 2003 Feb;37(2):307-15
references: 12563200
references: J Vasc Surg. 2011 Sep;54(3):730-5; discussion 735-6
references: 21802888
references: Eur J Vasc Endovasc Surg. 2010 Jun;39(6):756-61
references: 20299245
references: Vascular. 2006 Mar-Apr;14(2):63-9
references: 16956473
references: Vasc Endovascular Surg. 2010 Nov;44(8):625-32
references: 20724288
references: J Vasc Surg. 2008 Dec;48(6 Suppl):11S-16S
references: 19084730
references: J Vasc Surg. 2006 Mar;43(3):498-503
references: 16520163
references: Int Angiol. 2011 Apr;30(2):156-63
references: 21427653
references: Circulation. 2001 Oct 23;104(17):2057-62
references: 11673346
references: J Vasc Surg. 2000 Jan;31(1 Pt 2):S1-S296
references: 10666287
references: J Vasc Surg. 2010 May;51(5 Suppl):18S-31S
references: 20435259
references: Health Technol Assess. 2010 Mar;14(14):1-210, iii-iv
references: 20307380
references: J Vasc Surg. 2006 Mar;43(3):504-512
references: 16520164
references: J Vasc Surg. 2008 Jul;48(1):128-36
references: 18502084
references: J Vasc Surg. 2011 Jul;54(1):109-15
references: 21397441
references: J Vasc Surg. 2007 Jan;45 Suppl S:S5-67
references: 17223489