Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: Do the results justify an attempt before bypass grafting?

Parsons, Richard E.; Suggs, William D.; Lee, James J.; Sánchez, Luis A.; Lyon, Ross T.; Veith, Frank J.

doi:10.1016/s0741-5214(98)70033-3

Cited by 116 publications

(74 citation statements)

References 28 publications

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“…We have demonstrated the feasibility of drug-eluting stents in infrapopliteal arterial lesions causing chronic limb ischemia. Compared to historical controls of PTA, our patients treated with drug-eluting stents demonstrated greater clinical patency at 1 year as evidenced by freedom from TVR during that time period [10,[21][22][23]. …”

Section: Discussionmentioning

confidence: 66%

Infrapopliteal drug‐eluting stents for chronic limb ischemia

Grant

White

Collins

et al. 2007

Cathet Cardio Intervent

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Objective: We report our experience with the elective placement of below-knee, drugeluting stents in patients with chronic limb ischemia. Background: Infrapopliteal percutaneous transluminal angioplasty has been associated with a lower rate of procedural success and high rate of restenosis because of the small size of the tibial vessels and the prevalence of calcified and diffuse atherosclerotic disease. Prior published data reports 3-year patency rates below 25%. Bare metal stents have been reported in bailout situations. Drug-eluting stents have markedly reduced restenosis compared to bare metal stents in the coronary vasculature, but there is little data supporting the use of these devices below the knee. Methods: Elective placement of drug-eluting stents in infrapopliteal lesions was performed on 10 patients with severe (≥Fontaine Stage IIb) claudication (n 5 1) or limb-threatening ischemia (n 5 9) (rest pain, nonhealing ulcers and gangrene). Results: A total of 17 drug-eluting stents were electively placed in 12 below-knee arteries in 10 patients, resulting in an average of 1.7 6 0.7 stents per patient. The mean lesion length was 24.8 6 10.9 mm, the mean total stent length was 38.3 6 19.1 mm, and the mean nominal stent diameter was 2.8 6 0.3 mm. One patient required target vessel revascularization (TVR) at 3 weeks because of stent thrombosis. TVR was 10% at 12.4 6 6.5 months of follow-up. Clinically driven angiography in three different patients was performed at 4, 15, and 16 months and confirmed drug-eluting stent patency in each case. Conclusions: The use of below-knee drug-eluting stents is feasible and appears to be safe in our small series of complex infrapopliteal lesions causing chronic limb ischemia. The occurrence of a single case of stent thrombosis warrants continued observation in this cohort. Prospective clinical trials will be necessary to confirm the benefits and justify the costs of this strategy for treating patients with infrapopliteal culprit lesions and chronic limb ischemia. '

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Section: Discussionmentioning

confidence: 66%

Infrapopliteal drug‐eluting stents for chronic limb ischemia

Grant

White

Collins

et al. 2007

Cathet Cardio Intervent

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“…[53,54,55] In diabetic patients extant and burden regarding infrapopliteal arterial diseases are well described in different literatures [56] , more over high post-PTA restenosis rates have also been consistently reported. [57,58,59] The impact of high infrapopliteal vessel restenosis rates are not clear on the prognosis of CLI patients, despite regarding high infrapopliteal PTA restenosis rates, the limb salvage rates appear more acceptable [60] when compared to open lower limb bypass. [61] Thus, there is an evolving impression, endorsed by societal guidelines [62,63] that favors potential near-term benefit of PTA as the "first line approach" in specific CLI patients in comparison to open surgery.…”

Section: Discussionmentioning

confidence: 99%

Current Trends and outcomes: Endovascular Management in Arteriosclerosis Obliterans (ASO) of Lower Limb Vessels

2016

ARC Journal of Surgery

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“…[1][2][3][4] However, in recent years due to the advances in imaging techniques, angioplasty equipment, and endovascular techniques there has been a certain trend towards the less invasive endovascular procedures like angioplasty with or without stenting.…”

Section: Discussionmentioning

confidence: 99%

Trends in Revascularization for Critical Limb Ischemia of Lower Limbs

L¹,

Francisco²

2014

jemds

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OBJECTIVE:To study the trends in revascularization procedures done for critical limb ischemia (CLI) of lower limbs. MATERIALS AND METHODS: Total of 166 revascularization procedures done for CLI by a single vascular surgeon between June 2010 and May 2014 at Kempegowda Institute of Medical Sciences Bangalore. Both endovascular and open bypass procedures for lower limb ischemia were included. This retrospective study was conducted to evaluate the outcomes of the procedures and to see the trends in the management of CLI of lower limb. Only elective cases were included in the study. Emergency revascularization procedures for acute limb ischemia and those below 45 years suspected to be thromboangiitis obliterans were excluded STUDY PERIOD: Review of 4 year experience from June 2010 to May 2014. Follow up period was 24 months. Patients were predominantly male (94%), of the 5 th and 7 th decade of life (Median age 60 years).All patients presented with chronic lower limb ischemia with critical limb ischemia. Commonest presentation was disabling claudication, rest pain with ulcerations and digital gangrene. Co morbid conditions included diabetes mellitus, smoking history, hypertension, hyperlipidemia, cardiac disease. Total procedures done: Open-104, Endovascular-62. Open procedures: Aorto-femoral (21) femoro-femoral (33) femoropopliteal (50). Primary endovascular revascularization procedures angioplasty alone (53 %) angioplasty + stenting (47 %). Complication rate was significantly higher and the mean hospital stay was significantly longer with open surgery (15%, 10 days) compared with endovascular surgery (0.08%, 4days) (P < 0.05). Furthermore the number of endovascular revascularization procedures done significantly increased from6% in the first period (June 2010-May 2011 to 61% in the last period (June2013-May2014). CONCLUSIONS: Endovascular procedures for CLI have largely replaced open surgical procedures. Angioplasty is a feasible, safe, and effective procedure with less morbidity and can be the procedure of choice for the primary and secondary treatment of CLI. Open bypass surgery can be reserved for lesions technically unsuitable for endovascular procedures and patients who do not demonstrate clinical improvement after angioplasty.

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Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: Do the results justify an attempt before bypass grafting?

Cited by 116 publications

References 28 publications

Infrapopliteal drug‐eluting stents for chronic limb ischemia

Infrapopliteal drug‐eluting stents for chronic limb ischemia

Current Trends and outcomes: Endovascular Management in Arteriosclerosis Obliterans (ASO) of Lower Limb Vessels

Trends in Revascularization for Critical Limb Ischemia of Lower Limbs

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