title: Outcomes of infrapopliteal endoluminal intervention for transatlantic intersociety consensus C and D lesions in patients with critical limb ischaemia.
abstract: BACKGROUND
  Recent data suggest that infrapopliteal percutaneous transluminal angioplasty (PTA) is a reasonable primary therapy for critical limb ischaemia (CLI). Based on the transatlantic intersociety consensus (TASC) classification, this has been found to be true for lesions classified as A, B or C. We report our experience with infrapopliteal PTA stratified by TASC classification.
  
  
  METHODS
  A retrospective study of patients who underwent infrapopliteal PTA with or without stenting from October 2007 to July 2011 was conducted, revealing 83 limbs. The primary outcome variables were freedom from reintervention and freedom from index limb amputation. Secondary outcomes were technical success, post-operative complications and survival. TASC classification was assessed for the individual vessel(s) chosen for intervention.
  
  
  RESULTS
  Median age was 76 years and radiological success was 86.75%. Average follow-up was 15 months. At 1 and 2 years, freedom from re-intervention, or amputation was 65.1% and 55.6%. Limb salvage was 77.7%. Within 2 years, 2% underwent bypass and 18% repeat infrapopliteal PTA. The 30-day mortality was 5%. Overall survival was 84.5%, 71.8% and 61.6% at 1, 2 and 3 years. Eighty-two per cent were classified as TASC D lesions. Radiological success was achieved in 100% of TASC C lesions in contrast to 86.7% of TASC D lesions. There was not a statistically significant relationship between primary outcomes and TASC D classification.
  
  
  CONCLUSIONS
  Given the encouragingly high rates of radiological success and limb salvage, an attempt at PTA is indicated as an alternative to primary amputation even in patients with radiologically demonstrated severe disease.
authors.affiliation: Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Tewksbury
authors.forename: Ben
authors.initials: B
authors.lastname: Pearch
authors.forename: Kendal
authors.initials: K
authors.lastname: Redmond
authors.forename: John
authors.initials: J
authors.lastname: Harper
authors.forename: Kerenaftali
authors.initials: K
authors.lastname: Klein
authors.forename: John
authors.initials: J
authors.lastname: Quinn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods* / Q000592:standards; D032921:Consensus; D057510:Endovascular Procedures / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D012955:Societies, Medical; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: endovascular; vascular