title: Infrapopliteal lesion morphology in patients with critical limb ischemia: implications for the development of anti-restenosis technologies.
abstract: OBJECTIVE
  To angiographically evaluate infrapopliteal arterial lesion morphology in a consecutive series of patients presenting with critical limb ischemia (CLI) and undergoing infrapopliteal angioplasty.
  
  
  METHODS
  A prospective analysis was undertaken of a consecutive series of CLI patients undergoing endovascular therapy in a tertiary referral center in the year 2011. Morphological assessment of baseline angiograms obtained prior to revascularization included lesion length, assessment of calcification using a semi-quantitative scoring system, and reference vessel diameter (RVD) measurement. Delta RVDs were assessed subtracting distal RVDs from proximal RVDs. A total of 197 infrapopliteal lesions in 105 CLI patients (n=106 limbs) were assessed. Of these, 136 lesions were treated by endovascular means.
  
  
  RESULTS
  The average length of treated lesions was 87.1±43.8 mm in stenoses and 124.0±78.3 mm in chronic occlusions (p<0.001). Mean RVD proximal to the lesions was 1.88 mm whereas it was 1.66 mm distal to the lesions (p≤0.03). Mean arterial calcification was 1.15.
  
  
  CONCLUSIONS
  This prospective angiographic series underlines the complex nature and extensive longitudinal involvement of infrapopliteal lesions in CLI patients. These findings should be taken into consideration for anti-restenosis concepts in this challenging subgroup of peripheral artery disease patients.
authors.affiliation: Clinical and Interventional Angiology, Swiss Cardiovascular Center, Inselspital, University Hospital of Bern, Switzerland.
authors.forename: Frederic
authors.initials: F
authors.lastname: Baumann
authors.forename: Rolf P
authors.initials: RP
authors.lastname: Engelberger
authors.forename: Torsten
authors.initials: T
authors.lastname: Willenberg
authors.forename: Dai-Do
authors.initials: DD
authors.lastname: Do
authors.forename: Christoph
authors.initials: C
authors.lastname: Kalka
authors.forename: Iris
authors.initials: I
authors.lastname: Baumgartner
authors.forename: Nicolas
authors.initials: N
authors.lastname: Diehm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods*; D003251:Constriction, Pathologic; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography; D055502:Secondary Prevention; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000628:therapy*