title: Below-The-Knee Angioplasty for Critical Limb Ischemia: Results of a Series of 157 Procedures and Impact of the Angiosome Concept.
abstract: BACKGROUND
  To evaluate the long-term clinical results of below-the-knee percutaneous transluminal angioplasty (BTK-PTA) with or without stenting, in patients with critical limb ischemia (CLI), and to determine factors affecting clinical results including the role of the angiosome concept.
  
  
  METHODS
  All patients undergoing primary BTK-PTA from January 2007 to December 2011 were included. Primary patency, assisted patency, limb salvage, survival, and wound healing were assessed using the Kaplan-Meier method. Predictors of patency, limb salvage, survival, and wound healing, including the role of the angiosome theory, were determined using multivariate models.
  
  
  RESULTS
  A total of 157 procedures were performed in 139 patients with CLI (Rutherford IV 10.8%; Rutherford V-VI 89.2%). Mean age was 74.2 years and 68.3% were men; 60% had diabetes and 31% renal insufficiency. PTA was confined to the infrapopliteal segment alone in 53.5% of cases. Technical success was 87.9%. Stents were placed in 42.6% of cases. The mean follow-up was 14.7 months (range, 1-67 months). Four-year primary and secondary patency were 51% and 61%, respectively. Limb salvage at 4 years was 68.8%. Complete wound healing was 52% at 4 years. Positive predictors of survival were the absence of renal insufficiency (P < 0.0001) and technical success (P = 0.029). Target vessel occlusion of >50% was a negative predictor of limb salvage (P = 0.0072). Positive predictors of wound healing were technical success (P = 0.0067), the absence of renal insufficiency (P < 0.0001) and continuity between a leg artery and a foot artery (P = 0.02).
  
  
  CONCLUSIONS
  BTK-PTA can be performed with favorable long-term results in patients with limited longevity. Secondary interventions may be necessary to maintain target vessel patency. In our experience, the angiosome concept had no impact on clinical success.
authors.affiliation: Department of Vascular Surgery, Charles Nicolle University Hospital, Rouen, France. Electronic address: mariepave@hotmail.com.
authors.forename: Marie
authors.initials: M
authors.lastname: Pavé
authors.affiliation: Department of Vascular Surgery, Charles Nicolle University Hospital, Rouen, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Benadiba
authors.affiliation: Department of Vascular Surgery, Côte de Nacre University Hospital, Caen, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Berger
authors.affiliation: Department of Vascular Surgery, Côte de Nacre University Hospital, Caen, France.
authors.forename: Djelloul
authors.initials: D
authors.lastname: Gouicem
authors.affiliation: Department of Vascular Surgery, Côte de Nacre University Hospital, Caen, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Hendricks
authors.affiliation: Department of Vascular Surgery, Charles Nicolle University Hospital, Rouen, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Plissonnier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016638:Critical Illness; D005260:Female; D005602:France; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016016:Proportional Hazards Models; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014945:Wound Healing