title: Clinical Implications of Additional Pedal Artery Angioplasty in Critical Limb Ischemia Patients With Infrapopliteal and Pedal Artery Disease.
abstract: OBJECTIVE
  To evaluate the clinical implications of additional pedal artery angioplasty (PAA) for patients with critical limb ischemia (CLI).
  
  
  METHODS
  Twenty-nine patients (mean age 77.8±8.6 years; 21 men) with CLI (32 limbs) presenting with de novo infrapopliteal and pedal artery (Kawarada type 2/3) disease were reviewed. The need for PAA was based on the existence of sufficient wound blush (WB) around the target wounds after conventional above-the-ankle revascularization. Fourteen patients with insufficient WB in 14 limbs received additional PAA, while 15 patients with sufficient WB in 18 limbs did not. The groups were compared for overall survival, limb salvage, and amputation-free survival within 1 year after the procedure. The wound healing rate, time to wound healing, and freedom from reintervention rate were also evaluated.
  
  
  RESULTS
  The success rate of additional PAA was 93% (13/14). All limbs with successful PAA achieved sufficient WB (13/13). Despite insufficient WB before the additional PAA, overall survival (86% vs 73%, p=0.350), limb salvage (93% vs 83%, p=0.400), amputation-free survival (79% vs 53%, p=0.102), and freedom from reintervention (64% vs 73%, p=0.668) rates were similar in both groups. Furthermore, the wound healing rate (93% vs 60%, p=0.05) was higher and time to wound healing (86.0±18.7 vs 152.0±60.2 days, p=0.05) was shorter in the patients who received PAA.
  
  
  CONCLUSIONS
  Additional PAA might improve the WB and clinical outcomes (especially speed and extent of wound healing) in patients with CLI attributed to infrapopliteal and pedal artery disease.
authors.affiliation: Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan tatsuya_nakama@med.miyazaki-u.ac.jp.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakama
authors.affiliation: Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ogata
authors.affiliation: Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Nishino
authors.affiliation: Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Furugen
authors.affiliation: Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Koiwaya
authors.affiliation: Department of Cardiovascular Surgery, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Furukawa
authors.affiliation: Department of Cardiovascular Surgery, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Eisaku
authors.initials: E
authors.lastname: Nakamura
authors.affiliation: Department of Cardiovascular Surgery, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yano
authors.affiliation: Department of Plastic and Reconstructive Surgery, Miyazaki Konan Hospital, Miyazaki, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Daian
authors.affiliation: Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Nehiro
authors.initials: N
authors.lastname: Kuriyama
authors.affiliation: Department of Cardiology, Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Yoshisato
authors.initials: Y
authors.lastname: Shibata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects; D016638:Critical Illness; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D012039:Regional Blood Flow; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014945:Wound Healing
keywords: angiosome; balloon angioplasty; below-the-ankle intervention; critical limb ischemia; infrapopliteal disease; limb salvage; occlusion; pedal artery; percutaneous transluminal angioplasty; peripheral artery disease; wound healing