title: [Long term results after invasive treatment of critical limb ischemia].
abstract: OBJECTIVE
  Surgical tibial bypass for critical limb ischemia is associated with significant morbidity, mortality, and graft failure, whereas percutaneous angioplasty and stenting has promising results. The objective of this study was the investigation of the long term results of below-knee percutaneous angioplasty for restoring straight inline arterial flow in patients with critical limb ischemia.
  
  
  METHODS
  The clinical and angiographic data of 281 consecutive patients with critical limb ischemia treated by PTA between 2008 and 2011 was evaluated in a prospective register. The aim of the revascularization was to achieve a straight inline flow to the wound with balloon angioplasty. Stent implantation was done in the case of recoil and flow limiting dissection. Primary end points were clinical success (relief of resting pain, healing of ulceration, limb survival) and major adverse events (death, myocardial infarction, major unplanned amputation, need for surgical revascularization, or major bleeding). Secondary end points were the angiographic result of the intervention, procedural data and consumption of angioplasty equipment. The impact of diabetic leg syndrome and the result of the angioplasty on the limb salvage was also investigated. We have analysed the impact of major amputation on long term mortality.
  
  
  RESULTS
  Mean age of patients was 72.5 ± 10.6 years and the follow-up period was 40.8 ± 9.7 months. Technical success was reached in 255 (90.7%) of the patient's: 255 limbs straight inline flow with good angiographic result was restored to at least one tibial vessel. Balloon angioplasty, stent implantation and rotational atherectomy was performed in 278 (98.9%), 74 (26.3%) and 2 patients (0.7%). From clinical end points the rest pain was ceased in 56.6%, the ulcer and the gangrena was healed in 73.5% and 46.5%. The long term limb survival was 73.5%; 65.8% in diabetic and 89.6% in non-diabetic leg syndrome (p = 0.001). The major adverse events at long-term follow-up occured in 122 (43.8%) patients. Death occured in 57 (20.3%) of the patients during the long-term follow-up: 38 (13.5%) vs. 19 (6.8%) in diabetic vs. non-diabetic leg subgroup, respectively (p = 0.932). Long-term limb saving occured in 72.3% vs. 84.6% of the patients dependening the procedure was successful or unsuccessful (p = 0.225).
  
  
  CONCLUSIONS
  Below-knee stent angioplasty for critical limb ischemia results in good clinical outcome, but the major adverse event rate is high. Diabetes mellitus is associated with a high rate of mortality and amputation. Orv. Hetil., 2017, 158(11), 418-425.
authors.affiliation: Kardiológiai és Vaszkuláris Központ, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Gaál József út 6-8., 1122.|Invazív Kardiológiai Osztály, Bács-Kiskun Megyei Kórház, A Szent-Györgyi Egyetem Oktató Kórháza Kecskemét.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Ruzsa
authors.affiliation: Invazív Kardiológiai Osztály, Bács-Kiskun Megyei Kórház, A Szent-Györgyi Egyetem Oktató Kórháza Kecskemét.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Kuti
authors.affiliation: Kardiológiai és Vaszkuláris Központ, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Gaál József út 6-8., 1122.
authors.forename: Balázs
authors.initials: B
authors.lastname: Berta
authors.affiliation: Invazív Kardiológiai Osztály, Bács-Kiskun Megyei Kórház, A Szent-Györgyi Egyetem Oktató Kórháza Kecskemét.
authors.forename: Károly
authors.initials: K
authors.lastname: Tóth
authors.affiliation: Invazív Kardiológiai Osztály, Bács-Kiskun Megyei Kórház, A Szent-Györgyi Egyetem Oktató Kórháza Kecskemét.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Bánsághi
authors.affiliation: Invazív Kardiológiai Osztály, Bács-Kiskun Megyei Kórház, A Szent-Györgyi Egyetem Oktató Kórháza Kecskemét.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Vámosi
authors.affiliation: Kardiológiai és Vaszkuláris Központ, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Gaál József út 6-8., 1122.
authors.forename: Kálmán
authors.initials: K
authors.lastname: Hüttl
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000379:methods*; D000800:Angioplasty, Balloon; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome
keywords: below-knee stent angioplasty; critical limb ischemia; kritikus végtagischaemia; percutan angioplastica; percutaneous angioplasty; térd alatti angioplastica