title: Clinical outcomes of endovascular treatments for critical limb ischemia with chronic total occlusive lesions limited to below-the-knee arteries.
abstract: BACKGROUND
  Diabetes mellitus tends to have the greatest impact on the smaller vessels and contributes significantly to occlusive disease from the popliteal artery distally.
  
  
  OBJECTIVE
  To evaluate the clinical outcomes after a balloon angioplasty with or without stent placement in diabetic patients with critical limb ischemia (CLI) by chronic total occlusion (CTO) limited to below-the-knee (BTK) arteries.
  
  
  METHODS
  From August 2005, patients who presented CLI and CTO limited to the BTK arteries, and who underwent endovascular treatment, were included in this study. The primary endpoints evaluated were technical success, limb salvage, and primary patency. The secondary endpoints evaluated were 30-day access site, intervention site, and systemic complications. Patency and limb salvage were evaluated using the Kaplan-Meier method and compared using Fisher's exact test.
  
  
  RESULTS
  The BTK endovascular treatment (EVT) was performed on 64 limbs. Technical success rate was 93.8% and limb salvage rate was 90.6%. Three of four limbs with technical failure and three of 60 limbs with technical success underwent BTK amputation and the comparison of these rates were significantly different (75% vs. 5%, P = 0.002). Primary patency rates for the limbs were 75% and 59.1% at 6-month and 12-month follow-up, respectively. Minor complications disappeared through the follow-up periods and there was no 30-day complication or systemic adverse events for the treated vessel.
  
  
  CONCLUSIONS
  Even though EVT for CLI in patients with diabetes and CTO in isolated BTK arteries does not have comparable primary patency, it can lead to a very high rate of limb salvage. This result can accentuate the importance of more blood flow to the foot by means of successful revascularization using EVT rather than long-term patency in CTO of isolated BTK arteries.
authors: Department of Radiology.
authors: Sang Woo
authors: SW
authors: Park
authors: Jun Seok
authors: JS
authors: Kim
authors: Ik Jin
authors: IJ
authors: Yun
authors: Jae Joon
authors: JJ
authors: Hwang
authors: Song Am
authors: SA
authors: Lee
authors: Hyun Keun
authors: HK
authors: Chee
authors: Seong-Hwan
authors: SH
authors: Chang
authors: Dong Hyeok
authors: DH
authors: Shin
authors: Hong Geun
authors: HG
authors: Jung
authors: Il Soo
authors: IS
authors: Chang
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D003287:Contrast Media; D048909:Diabetes Complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging; D023821:Limb Salvage; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants; D003287:Contrast Media
keywords: CT; Intervention; arteries; fluoroscopy; percutaneous transluminal angioplasty