Endovascular Treatment for Infrainguinal Vessels in Patients With Critical Limb Ischemia

Abstract

Background— Recent technical advances have made endovascular treatment (EVT) an alternative first-line treatment for critical limb ischemia. Methods and Results— A prospective multicenter study was conducted to evaluate the clinical outcomes of 314 Japanese critical limb ischemia patients (mean age, 73±10 years) with infrainguinal arterial lesions who underwent EVT. Patients were enrolled from December 2009 to July 2011 and were followed-up for 12 months. The primary end point was amputation-free survival (AFS) at 12 months. Secondary end points were anatomic, clinical, and hemodynamic measures, including 12-month freedom from major adverse limb events. The 12-month AFS rate was 74%, with body mass index <18.5 (hazard ratio [HR], 2.22; P =0.008), heart failure (HR, 1.73; P =0.04), and wound infection (HR, 1.89; P =0.03) associated with a poor prognosis for AFS. The 12-month major adverse limb event-free rate was 88%, with hemodialysis (HR, 1.98; P =0.005), heart failure (HR, 1.69; P =0.02), and Rutherford classification 6 (HR, 2.25; P =0.002) associated with a poor prognosis for major adverse limb events. The median time for wound healing was 97 days, with body mass index <18.5 (HR, 0.54; P =0.03) and wound infection (HR, 0.60; P =0.04) being significant risk factors for unhealed wounds after EVT. At 12 months, 34% had undergone reintervention (bypass surgery, 2.6%; repeat EVT, 31.7%), and 73% were major adverse event–free. Conclusions— The high reintervention rate notwithstanding, EVT was an effective treatment for Japanese critical limb ischemia patients with infrainguinal disease, with satisfactory AFS and major adverse limb event-free rates. The results of this study will be helpful for the future evaluation of critical limb ischemia therapy. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr . Unique identifier: UMIN000002830.

The concept of surgical treatment of critical limb ischemia

“…В настоя-щее время от 70 до 90% ампутаций в мире проводят по по-воду КИНК, в России этот показатель еще выше [8,9,22]. При ампутации ноги резко снижается качество жизни, уменьшается ее продолжительность [32,33,41]. С хирур-гической точки зрения, ампутация у больных данной ка-тегории не может являться операцией выбора.…”

“…Про-блема ЧКА заключается в быстром «рестенозе» берцовых артерий. При коррекции кровотока по голени состояние конечности возвращается на дооперационный уровень у 48% оперированных в течение 1 года [15,33,34]. Призна-ки рестеноза при контрольном обследовании обнаружи-вают у 2 / 3 больных уже через 3 мес [48].…”

Role of vascular endothelial growth factor in inducing production of angiopoetin-1 – in vivo study in Fisher rats

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The Formation of Blood Vessel After the Administration of the Plasmid Encoding Ang-1 Gene in Fischer Rats

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“…Within one year after the diagnosis, more than 30% of patients with lower limb CLI require amputation [1][2][3][4].…”