PTA of Infrapopliteal Arteries: Long-term Clinical Follow-up and Analysis of Factors Influencing Clinical Outcome

Abstract

This study was a retrospective analysis of patients with CLI who underwent infrapopliteal percutaneous transluminal angioplasty (PTA). The main goal was to evaluate clinical and morphological factors that influence the clinical outcome of PTA in long-term follow-up. A total of 1,445 PTA procedures were performed in 1,268 patients. Main indications for PTA included gangrene, nonhealing ulcers, or rest pain. The mean number of treated arteries was 1.77 artery/limb, and the majority of lesions were type TASC D. The technical success rate of PTA was 89% of intended-to-treat arteries. The main criterion of clinical success was functional limb salvage (LS). One-year follow-up involved 1,069 limbs. Primary and secondary 1-year LS rates were 76.1 and 84.4%, respectively. The effect of clinical and morphological parameters on the 1-year LS was that the only associated disease with an adverse effect on LS rate was DM combined with dialysis. Regarding limb preprocedural status, gangrene was clearly a negative predictor. The most important factor affecting LS was the number of patent arteries post-PTA: patients with 0, 1, 2, and 3 patent arteries had 1-year primary LS rates of 56.4, 73.1, 80.4, and 83%, respectively. Long-term follow-up of LS rates demonstrated secondary LS rates of 84.4, 78.8, and 73.3% at 1, 5, and 10 years. Every effort should be made to perform PTA for as many arteries as possible, even if TASC D type, to improve clinical outcome. Our study shows that repeat PTA is capable of keeping the long-term LS rate close to 75%.

Sirolimus-Eluting Stents for Treatment of Infrapopliteal Arteries Reduce Clinical Event Rate Compared to Bare-Metal Stents

“…Abbreviations as in Figure 1. (13)(14)(15). In this context, results of the present study support findings that the degree of IC is positively affected by successful and long-lasting interventions of IPA lesions (4,5,16).…”

Long-Term Results of Combined Aortoiliac and Infrainguinal Arterial Reconstruction for the Treatment of Critical Limb Ischemia

“…22,23) The hybrid approach appears to be a valuable alternative to completely open or endovascular procedures. Recently, the treatment options of CLI have included the aggressive application of EVT to treat more widespread lesions of the iliac artery, superfi cial femoral artery (SFA), and infrapopliteal artery, 1,24,25) in addition to hybrid procedures such as EVT of the SFA combined with distal or infrainguinal bypass and EVT of infrapopliteal lesions. 26) Clarifi cation of the effi cacy of these strategies requires additional studies and experiences.…”

Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

“…Imaging interrogation of the peripheral arteries must extend from the level of the infrarenal abdominal aorta to the feet in order to provide a global view of potential approach, access vessels for treatment, identify anatomical variants, exclude aneurysmal disease, assess any inflow and outflow disease, and assess the suitability of vessels for revascularization in line with the angiosome concept [33,34]. Digital subtraction angiography (DSA) is invasive with attendant risks of haemorrhage, vessel injury, and embolization and therefore must be reserved for cases where noninvasive imaging is inadequate.…”