title: Cutting Balloon Angioplasty in the Treatment of Short Infrapopliteal Bifurcation Disease.
abstract: OBJECTIVE
  To evaluate the safety, feasibility, and effectiveness of cutting balloon angioplasty in the management of infrapopliteal bifurcation disease.
  
  
  METHODS
  Between November 2010 and March 2013, 23 patients (mean age 69.6±9.01 years, range 56-89; 16 men) suffering from critical limb ischemia were treated using cutting balloon angioplasty (single cutting balloon, T-shaped double cutting balloon, or double kissing cutting balloon technique) for 47 infrapopliteal artery bifurcation lesions (16 popliteal bifurcation and 9 tibioperoneal bifurcation) in 25 limbs. Follow-up consisted of clinical examination and duplex ultrasonography at 1 month and every 3 months thereafter.
  
  
  RESULTS
  All treatments were technically successful. No 30-day death or adverse events needing treatment were registered. No flow-limiting dissection was observed, so no stent implantation was necessary. The mean postprocedure minimum lumen diameter and acute gain were 0.28±0.04 and 0.20±0.06 cm, respectively, with a residual stenosis of 0.04±0.02 cm. Primary and secondary patency rates were estimated as 89.3% and 93.5% at 6 months and 77.7% and 88.8% at 12 months, respectively; 1-year primary and secondary patency rates of the treated bifurcation were 74.2% and 87.0%, respectively. The survival rate estimated by Kaplan-Meier analysis was 82.5% at 1 year.
  
  
  CONCLUSIONS
  Cutting balloon angioplasty seems to be a safe and effective tool in the routine treatment of short/ostial infrapopliteal bifurcation lesions, avoiding procedure-related complications, overcoming the limitations of conventional angioplasty, and improving the outcome of catheter-based therapy.
authors.affiliation: Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy roberto.iezzi@rm.unicatt.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Iezzi
authors.affiliation: Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Posa
authors.affiliation: Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Santoro
authors.affiliation: Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Nestola
authors.affiliation: Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Contegiacomo
authors.affiliation: Institute of Vascular Surgery, "A. Gemelli" Hospital, Catholic University, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tinelli
authors.affiliation: Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Paolini
authors.affiliation: Department of Medicine, "A. Gemelli" Hospital, Catholic University, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Flex
authors.affiliation: Department of Medicine, "A. Gemelli" Hospital, Catholic University, Rome, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Pitocco
authors.affiliation: Institute of Vascular Surgery, "A. Gemelli" Hospital, Catholic University, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Snider
authors.affiliation: Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency
keywords: angiosome; balloon angioplasty; bifurcation; critical limb ischemia; cutting balloon; infrapopliteal arteries; popliteal artery; revascularization; tibial artery