Balloon angioplasty of popliteal and crural arteries in elderly with critical chronic limb ischemia

Atar, Eli; Siegel, Yoel; Avrahami, Ram; Bartal, Gabriel; Bachar, Gideon; Belenky, Alexander

doi:10.1016/j.ejrad.2004.02.016

Cited by 51 publications

(29 citation statements)

References 23 publications

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“…[4][5][6] While SA might be an effective alternative for treating below-the-ankle arterial occlusion, the small arteries of the foot See commentaries pages 613 and 617 are particularly challenging. SA has been attempted in only a limited number of belowthe-ankle occlusions, 8,9 and no studies have examined the technical and clinical outcomes, complication rate, and patency of this procedure.…”

mentioning

confidence: 98%

Subintimal Angioplasty for Below-the-Ankle Arterial Occlusions in Diabetic Patients With Chronic Critical Limb Ischemia

Zhang

Zhao

Liu

et al. 2009

Journal of Endovascular Therapy

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¤ ¤Purpose: To assess the feasibility and efficacy of subintimal angioplasty (SA) in the treatment of below-the-ankle arterial occlusion in diabetic patients with chronic critical limb ischemia (CLI). Methods: SA was applied in 37 diabetic patients (24 men; mean age 70.968.5 years, range 52-88) with chronic CLI and occlusive disease of the dorsalis pedis artery (DPA) and/or plantar artery (PA) but were poor candidates for intraluminal angioplasty or bypass surgery. Tissue loss was present in 31 (54.4%) of 57 afflicted limbs, and rest pain was reported in 51 (89.5%) limbs. SA was performed to create continuous arterial flow to the foot for limb salvage. The clinical symptoms, DPA or PA pulse volume scores, and anklebrachial index (ABI) were compared before and after SA. Wound healing, amputation, and restenosis of target vessels were also evaluated at follow-up. Kaplan-Meier curves were constructed to evaluate limb salvage, survival, and freedom from amputation. Results: Below-the-ankle SA was performed successfully in 55 (83.3%) of 66 arteries in 57 limbs. Median pulse volume scores and ABIs were 0.3360.55 and 0.3160.19 before SA and 2.0461.05 and 0.8060.14 after SA, respectively (p,0.0001 for both). The 30-day mortality was 2.7%. Median follow-up was 9.166.1 months (range 1-18). Major complications occurred in 1 (2.7%) patient and minor complications in 3 (8.1%). Twelve months after SA, Kaplan-Meier analysis showed that the limb salvage rate was 94.6%, the freedom from amputation was 89.2%, and the survival rate was 97.3%. Conclusion: SA of the dorsalis pedis artery and/or plantar artery is a useful technique for lower limb salvage in diabetic patients with chronic CLI who are not candidates for bypass surgery.

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mentioning

confidence: 98%

Subintimal Angioplasty for Below-the-Ankle Arterial Occlusions in Diabetic Patients With Chronic Critical Limb Ischemia

Zhang

Zhao

Liu

et al. 2009

Journal of Endovascular Therapy

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“…Still unanswered is the need of long-term patency for patients with CCLI and nonhealing ulcers. Atar et al [15] reported a low clinical Fig. 1a-d Angiograms of a patient who presented with PVD Rutherford stage 5. a, b Prior to the intervention a total chronic occlusion of the distal SFA, and the popliteal artery with refill of the anterior tibial artery was observed.…”

Section: Discussionmentioning

confidence: 97%

“…With the elderly population, it is estimated that nearly 6-10% will have intermittent claudication, and of these 10-20% will be at risk for severe limb-threatening Refused -ischemia, requiring revascularization or even amputation [15]. Age, diabetes, and hypertension are factors that hinder the healing of ischemic wounds.…”

Section: Discussionmentioning

confidence: 99%

Self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty

et al. 2006

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The feasibility of self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty was assessed. Options for lower limb percutaneous revascularization are limited, especially for complex vessel obstruction. Depending on the lesion and the experience of the interventionalist, the failure rate of balloon angioplasty (PTA) ranges between 10 and 40%. Until recently, no self-expanding stent for the use in the infragenicular arteries was available. This is the first report of the results for 18 consecutive patients who received 4F sheath compatible self-expanding nitinol stents following unsuccessful PTA or early restenosis. Twenty-four stents were implanted in 21 lesions for various indications residual stenosis >50% due to heavy calcification, flow-limiting dissection, occluding thrombus resistant to thrombolyis, thrombaspiration, and PTA, and early restenosis after previous PTA. Stent implantation was feasible in all cases. No complications occurred. After the stent implantation, all primarily unsuccessful interventions could be transformed into successful procedures with no residual stenosis >30% in any case. After 6 +/- 2 months, two of the 18 patients died, and 14 of the 16 remaining patients improved clinically. At follow-up, the patency could be assessed in 14 stented arteries. Three stents were occluded, one stent showed some neointimal hyperplasia (50-70% restenosis), the remaining ten stents showed no restenosis (0-30%). The use of self-expanding nitinol stents in tibioperoneal and popliteal arteries is a safe and feasible option for the treatment of unsuccessful PTA. The 6-months patency is high.

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“…However, there are also substantial differences in healing time between neuropathic and ischaemic/neuroischaemic DFUs even after successful revascularization. In fact, healing rates are around 80% after 4 months of treatment in cases of neuropathy without PAD and only 40% after 6 months, whereas the rate is around 70% after 12 months with PAD, even with successful revascularization [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]71]. Thus, it is essential to look beyond macroangiopathy and the concept of vascular stenosis.…”

Section: The Link Between Healing and Pad: Room For Other Actorsmentioning

confidence: 98%

Lower-extremity arterial revascularization: Is there any evidence for diabetic foot ulcer-healing?

Vouillarmet

Bourron

Gaudric³

et al. 2016

Diabetes & Metabolism

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Balloon angioplasty of popliteal and crural arteries in elderly with critical chronic limb ischemia

Cited by 51 publications

References 23 publications

Subintimal Angioplasty for Below-the-Ankle Arterial Occlusions in Diabetic Patients With Chronic Critical Limb Ischemia

Subintimal Angioplasty for Below-the-Ankle Arterial Occlusions in Diabetic Patients With Chronic Critical Limb Ischemia

Self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty

Lower-extremity arterial revascularization: Is there any evidence for diabetic foot ulcer-healing?

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