Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia

Romiti, Marcello; Albers, Maximiano; Brochado-Neto, Francisco Cardoso; Durazzo, A; Pereira, Carlos Alberto de Bragança; Luccia, Nélson De

doi:10.1016/j.jvs.2008.01.005

Cited by 487 publications

(370 citation statements)

References 34 publications

(10 reference statements)

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“…In line with the BASIL‐trial, indirect comparisons of endovascular procedures66, 67 and open bypass surgery using a vein graft11 show similar results with respect to 1‐year limb salvage and mortality rates in CLI, both ranging from 85% to 90%, but a higher need for reinterventions after endovascular therapy 68. This increased reintervention rate corresponds with an increase in the number of endovascular interventions in both claudication and CLI over the years that outnumbers the decline in open surgical interventions.…”

Section: Revascularization Strategies In CLImentioning

confidence: 72%

Critical Limb Ischemia: Current Trends and Future Directions

Teraa

Conte

Moll

et al. 2016

JAHA

197

150

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Section: Revascularization Strategies In CLImentioning

confidence: 72%

Critical Limb Ischemia: Current Trends and Future Directions

Teraa

Conte

Moll

et al. 2016

JAHA

197

150

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“…In a meta-analysis comparing the results of the surgical and endovascular approach of BTK area, Romiti et al [32] reported a rate of limb salvage at 3 years that was comparable for the two techniques (PTA 82.4 ± 3.4, surgery 82.3 ± 3.0). Several other studies [23][24][25][26][27][28][29][30] evaluated the effectiveness of PTA in diabetic foot patients, but these studies are limited by their main conditions, including a heterogeneous population with BTK and/or ATK disease.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Diabetic Foot in a Selected Population of Patients with Below-the-Knee Disease: Is the Angiosome Model Effective?

Fossaceca

Guzzardi

Cerini

et al. 2013

Cardiovasc Intervent Radiol

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Purpose To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in a selected population of diabetic patients with below-the-knee (BTK) disease and to analyze the reliability of the angiosome model. Methods We made a retrospective analysis of the results of PTA performed in 201 diabetic patients with BTK-only disease treated at our institute from January 2005 to December 2011. We evaluated the postoperative technical success, and at 1, 6, and 12 months' follow-up, we assessed the rates and values of partial and complete ulcer healing, restenosis, major and minor amputation, limb salvage, and percutaneous oximetry (TcPO 2 ) (Student's t test). We used the angiosome model to compare different clinicolaboratory outcomes in patients treated by direct revascularization (DR) from patients treated with indirect revascularization (IR) technique by Student's t test and the v 2 test. Results At a mean ± standard deviation follow-up of 17.5 ± 12 months, we observed a mortality rate of 3.5 %, a major amputation rate of 9.4 %, and a limb salvage rate of 87 % with a statistically significant increase of TcPO 2 values at follow-up compared to baseline (p \ 0.05). In 34 patients, treatment was performed with the IR technique and in 167 by DR; in both groups, there was a statistically significant increase of TcPO 2 values at follow-up compared to baseline (p \ 0.05), without statistically significant differences in therapeutic efficacy. Conclusion PTA of the BTK-only disease is a safe and effective option. The DR technique is the first treatment option; we believe, however, that IR is similarly effective, with good results over time.

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“…Percutaneous transluminal angioplasty (PTA) or balloon angioplasty is the current standard of therapy, with a technically successful result (<30% residual stenosis) in the majority of cases (77-100%), but is limited by high restenosis rates [16,17]. Flexible, low profile, balloons have enhanced the ability to cross, and successfully treat, focal, multi-focal, diffuse, and occlusive lesions.…”

Section: Percutaneous Transluminal Angioplastymentioning

confidence: 99%

SCAI expert consensus statement for infrapopliteal arterial intervention appropriate use

Gray

Díaz‐Sandoval

Dieter

et al. 2014

Cathet Cardio Intervent

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Intervention to treat infrapopliteal arterial disease can be challenging because the patients' comorbidities, the anatomic variables, and the limitations of our techniques. Clinical scenarios based on anatomic and clinical variables are presented. Recommendations regarding intervention (appropriate care, may be appropriate care, rarely appropriate care) are made based on best evidence. V C 2014 Wiley Periodicals, Inc.Key words: peripheral intervention; appropriate use; peripheral arterial disease INTRODUCTION Infrapopliteal (IP) arterial disease or "below the knee" arterial disease is commonly seen in patients with long-standing diabetes mellitus, chronic kidney disease, or the elderly. The most concerning manifestation of peripheral arterial disease (PAD) in these high risk patients is the development of critical limb ischemia (CLI: ischemic rest pain or ischemic ulcers). This arterial bed consists of relatively small caliber vessels, which are often calcified and associated with diffuse, multilevel disease. Due to the complexity of this patient population, their co-morbidities, and severity of vascular disease, there is a paucity of scientific evidence for the generalizability of percutaneous revascularization.In general, non-ambulatory patients with a short life expectancy and extensive necrosis or gangrene should undergo primary amputation. Ambulatory patients who are acceptable surgical candidates, expected to survive more than two years with a patent IP artery that provides direct flow to the foot (considered to be a good distal target), and an adequate autologous venous conduit should be considered for surgical bypass. Patients with significant medical co-morbidities that limit life expectancy, those at increased risk for surgery, those without an adequate distal target for bypass, or with poor venous conduit should be considered for an endovascular-first approach.This document was developed to guide physicians in clinical decision-making in the modern practical application of endovascular intervention for patients with IP arterial disease. ANATOMIC CONSIDERATIONSPatients with CLI typically have disease involving multiple levels (i.e., aorto-iliac, femoropopliteal (FP) and IP), but less than 10% of patients with CLI have hemodynamically significant disease in all three levels [1][2][3] (Table I). Infrainguinal disease (FP and IP) can be further subdivided into those with predominantly isolated IP disease ( 33%) and those with both FP and IP disease ( 67%) [4][5][6][7].Additional Supporting Information may be found in the online version of this article. Catheterization and Cardiovascular Interventions 84:539-545 (2014) Isolated IP disease is mainly seen in the elderly (>80-years old), diabetic, or dialysis-dependent patients [5]. These patients are at higher risk for amputation and have a shorter amputation-free survival compared to those with FP and IP disease (median amputation-free survival: 17 months (95% CI ¼ 9-24 m) versus 37 months (95% CI ¼ 28-44 m), P ¼ 0.001) [6]. Clinical and non-invasive cr...

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Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia

Cited by 487 publications

References 34 publications

Critical Limb Ischemia: Current Trends and Future Directions

Critical Limb Ischemia: Current Trends and Future Directions

Endovascular Treatment of Diabetic Foot in a Selected Population of Patients with Below-the-Knee Disease: Is the Angiosome Model Effective?

SCAI expert consensus statement for infrapopliteal arterial intervention appropriate use

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