title: Clinical efficacy of successful angioplasty in critical ischemia--a cohort study.
abstract: BACKGROUND
  To evaluate the impact of percutaneous angioplasty (PA), objectively assessed with duplex-ultrasound, on 3-year clinical outcome.
  
  
  METHODS
  Thirty-nine patients with atherosclerotic disease successfully treated by PA were included (40 limbs). All patients had critical ischemia with rest pain and ischemic ulcers due to infrainguinal obstructions alone. The patients were submitted to duplex ultrasound examination on the day before and on the first or second day after the procedure. Peak systolic velocities (PSV) were recorded in the anterior tibial, posterior tibial, and fibular arteries at the level of distal third of the leg. All patients were followed for 3 years. Comparison between groups with good and bad results were based on perioperative VPS gradient (GPSV) of the mean of the VPS in the 3 arteries. After 3 years, a good result was defined as a patient having no pain and complete healing of a previous ulcer or minor amputations.
  
  
  RESULTS
  Mean age was 68.5±8.1 years with no difference in demographic characteristics (P>0.05). In 26 cases, the long-term result was good. Healing time ranged from 4 to 130 weeks (median 26.5). Bad long-term results were observed in 12 cases. Two lesions remained unhealed despite patent angioplasty. In 10 cases, a second procedure was carried out (repeat angioplasty in 6 and bypass in 4). TransAtlantic Inter-Society Consensus (TASC) II category A/B registered better clinical success then TASC II category C/D (P<0.05) at 1-year follow-up but not at 3 years (P=0.36). Two-year limb salvage was 92.5%±4.2%. Primary patency was 52.5%±9.5% at 3 years. GVPS was 21.9 cm/sec in the good results group and 24.7 cm/sec in the bad results group (P>0.05). The quality of the initial result, as measured by GPSV, was not associated with long-term success (P>0.05).
  
  
  CONCLUSIONS
  An initially successful procedure indicated by the degree of increased flow is not related to long-term durability and ulcer healing.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery and Department of Radiology, Hospital das Clínicas, University of São Paulo Faculty of Medicine, São Paulo, Brazil.
authors.forename: Tais Bugs
authors.initials: TB
authors.lastname: Wakassa
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery and Department of Radiology, Hospital das Clínicas, University of São Paulo Faculty of Medicine, São Paulo, Brazil.
authors.forename: Joseph Elias
authors.initials: JE
authors.lastname: Benabou
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery and Department of Radiology, Hospital das Clínicas, University of São Paulo Faculty of Medicine, São Paulo, Brazil. Electronic address: pedro@puech.com.br.
authors.forename: Pedro
authors.initials: P
authors.lastname: Puech-Leão
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000379:methods*; D001783:Blood Flow Velocity; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency