Percutaneous transluminal angioplasty of crural arteries.

Abstract

The authors dilated 103 stenosed crural arteries in 71 patients. Primary success was defined as traversing and reducing the lesion to a residual stenosis of less than 30%. This was achieved in 96% of cases. Complications included one vessel rupture and one occluding intimal flap, which were treated by the vascular surgeon with bypass and venous patch, respectively. One hematoma at the puncture site was treated surgically because of its size. With modern materials such as steerable guide wires and low-profile balloon catheters, dilation of crural arteries has become safe. Until now, the indications for percutaneous transluminal angioplasty (PTA) of crural arteries have been limited to Fontaine stages III and IV disease. The authors believe that the indications for PTA in Fontaine stage IIb disease are justified, especially if intervention improves outflow after a more proximal recanalizing procedure is performed.

Initial Clinical Experience with the 4-F Self-expanding XPERT Stent System for Infrapopliteal Treatment of Patients with Severe Claudication and Critical Limb Ischemia

“…INFRAPOPLITEAL percutaneous transluminal angioplasty (PTA) in the therapy of lifestyle-limiting claudication (LLC) or critical limb ischemia (CLI) has been controversial (1)(2)(3)(4)(5)(6)(7). Some authors emphasize the potential alternative role of infrapopliteal PTA in focal stenoses and occlusion with special regard to limb salvage (1-3,8 -11).…”

Recanalization of infrapopliteal occlusions

“…Presentation may be quite late in the disease process. This perhaps reflects the body's ability to form extensive collateral circulation below the knee, so that only one crural vessel may be sufficient for d istal perfusion [3,8].…”

“…Generally, 20% of claudicants have multisegment involvement including the below-knee vessels [24], and it is exceptionally rare to find isolated below-knee atherosclerotic disease in this group [7]. Because of the low occurrence of disease, lack of evidence and attendant risks, endovascular treatment of run-off vessels in claudicants is not recommended, although some would advocate or suggest treatment in severe claudication [4,7,8]. Although controversial, crural angioplasty may also be useful to maintain adequate run-off -and hence patency -following femoral popliteal angioplasty or stenting, or femoral distal surgical bypass [5,8,25].…”

“…Lower rates (88%) for occlusions reflect an increased risk of vessel rupture or unsuccessful recanalization in these lesions [7,8,26]. Vessel recoil and osteal lesions can also present technical difficulties.…”

“…With regular Doppler ultrasound surveillance, 1-year patency rates of up to 79% can be achieved [8]. Minimal reintervention is required to assist patency.…”