The acute outcome of tibioperoneal vessel angioplasty in 417 cases with claudication and critical limb ischemia

Dorros, Gerald; Jaff, Michael R.; Murphy, Kelly J.; Mathiak, Lynne

doi:10.1002/(sici)1097-0304(199811)45:3<251::aid-ccd7>3.0.co;2-e

Cited by 48 publications

(23 citation statements)

References 29 publications

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“…While this finding is not universally true in prior studies, it is a well-documented phenomenon. 24,28 Importantly, this was the single risk factor which remained predictive of reduced primary patency on multivariate analysis. This argues that the reduced patency in diabetic patients is largely a result of their propensity to present with limb-threatening ischemia, as this was the indication for intervention in 52.5% of diabetics and only 36.2% of nondiabetics.…”

Section: Discussionmentioning

confidence: 91%

Reduced primary patency rate in diabetic patients after percutaneous intervention results from more frequent presentation with limb-threatening ischemia

DeRubertis

Pierce

Ryer

et al. 2008

Journal of Vascular Surgery

111

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Objective: Although patients with diabetes are at increased risk of amputation from peripheral vascular disease, excellent limb-salvage rates have been achieved with aggressive surgical revascularization. It is less clear whether patients with diabetes will fare as well as nondiabetics after undergoing percutaneous lower extremity revascularization, a modality which is becoming increasingly utilized for this disease process. This study aimed to assess differential outcomes in between diabetics and nondiabetics in lower extremity percutaneous interventions. Methods: We retrospectively studied 291 patients with respect to patient variables, complications, and outcomes for percutaneous interventions performed for peripheral occlusive disease between 2002 and 2005. Tibial vessel run-off was assessed by angiography. Patency (assessed arterial duplex) was expressed by Kaplan-Meier method and log-rank analysis. Mean follow-up was 11.6 months (range 1 to 56 months). Results: A total of 385 interventions for peripheral occlusive disease with claudication (52.2%), rest pain (16.4%), or tissue loss (31.4%) were analyzed, including 336 primary interventions and 49 reinterventions (mean patient age 73.9 years, 50.8% male). Comorbidities included diabetes mellitus (57.2%), chronic renal insufficiency (18.4%), hemodialysis (3.8%), hypertension (81.9%), hypercholesterolemia (57%), coronary artery disease (58%), tobacco use (63.2%). Diabetics were significantly more likely to be female (55.3% vs 40.8%), and suffer from CRI (23.5% vs 12.0%), a history of myocardial infarction (36.5% vs 18.0%), and

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Section: Discussionmentioning

confidence: 91%

Reduced primary patency rate in diabetic patients after percutaneous intervention results from more frequent presentation with limb-threatening ischemia

DeRubertis

Pierce

Ryer

et al. 2008

Journal of Vascular Surgery

111

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“…Patient evaluation and interventional techniques have been published. 8 Clinical follow-up was obtained through periodic outpatient visits, direct phone call assessments, and correspondence with the primary physician, with attention directed to the presence of ischemic rest pain, resolution of the ischemic tissue injuries, amputation, and causes of death. Ankle-brachial indexes (ABIs) and plethysmography were not performed in patients with obvious advanced ischemic disease.…”

Section: Methodsmentioning

confidence: 99%

“…[5][6][7] The need for emergency surgery after tibioperoneal vessel angioplasty (TPVA), however, appears to be overstated. 8 This communication details the acute outcome of 235 CLI patients with 284 ischemic limbs who, often after ipsilateral inflow lesion balloon angioplasty, underwent balloon angioplasty of infrapopliteal tibioperoneal vessel outflow lesions. The 5-year follow-up of 215 of 221 successful CLI patients (97%) and 266 successfully revascularized limbs delineated the occurrence of surgical bypass, amputation, and survival.…”

mentioning

confidence: 99%

Tibioperoneal (Outflow Lesion) Angioplasty Can Be Used as Primary Treatment in 235 Patients With Critical Limb Ischemia

Dorros¹,

Jaff²,

Dorros³

et al. 2001

Circulation

Self Cite

290

155

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Background-In a prospective, nonrandomized, consecutive series of tibioperoneal vessel angioplasty (TPVA), critical limb ischemia (CLI) patients' data were analyzed with regard to immediate and follow-up success. Methods and Results-TPVA was successful in 270 of 284 critically ischemic limbs (95%), with 167 limbs (59%) requiring dilatation of 333 ipsilateral inflow obstructions to access and successfully dilate 486 of 529 (92%) tibioperoneal lesions. A clinical success (relief of rest pain or improvement of lower-extremity blood flow) was attained in 270 limbs at risk (95%). Clinical 5-year follow-up of 215 of 221 successful CLI patients (97%) with 266 successfully revascularized limbs revealed that bypass surgery occurred in 8% and significant amputations in 9% of limbs; 91% of the limbs were salvaged. The cohort's probability of survival was 56%: 58% for Fontaine class III and 33% for class IV patients. Class III compared with class IV patients had significantly (PϽ0.05) fewer surgical bypasses (3% versus 16%) and amputations: above-knee, 1% versus 4%; below-knee, 3% versus 12%; and transmetatarsal, Ͻ1% versus 21%. Conclusions-TPVA, often in combination with inflow lesions, is an effective primary treatment for critical limb ischemia.The poor cumulative survival reflects the existence of severe comorbidities, which could potentially be affected by aggressive and effective cardiovascular diagnostic and therapeutic strategies.

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“…Most reports of tibioperoneal angioplasty are series of patients with critical limb ischaemia (3-6, 11, 14, 16, 21, 25, 29, 31, 33-35, 37, 39, 47) several of which include patients with diabetes (6,14,31,33). Critical limb ischaemia in these patients presented clinically as rest pain, ulcers and gangrene.…”

Section: Results In the Literaturementioning

confidence: 99%

Tibioperoneal Angioplasty and Bypass

Baird

Bradley

Murphy

2003

Acta Chirurgica Belgica

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Revascularisation by angioplasty or bypass of narrowing and occlusion of the tibio-peroneal segment is done infrequently compared with the more proximal arteries, particularly the superficial femoral artery. The indication for intervention is critical limb ischaemia and the pattern of disease when it predominantly affects the calf arteries is most commonly seen in diabetics. Surgical bypass is the orthodox technique, with well-documented long-term results. Balloon dilation has recently been tried, particularly using the sub-intimal technique. The advantage of minimal invasiveness has to be set against the inapplicability of the method if severe calcification is present, as is often the case in diabetics, the high restenosis rate, and the absence of controlled trials showing good evidence of long-term patency.

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The acute outcome of tibioperoneal vessel angioplasty in 417 cases with claudication and critical limb ischemia

Cited by 48 publications

References 29 publications

Reduced primary patency rate in diabetic patients after percutaneous intervention results from more frequent presentation with limb-threatening ischemia

Reduced primary patency rate in diabetic patients after percutaneous intervention results from more frequent presentation with limb-threatening ischemia

Tibioperoneal (Outflow Lesion) Angioplasty Can Be Used as Primary Treatment in 235 Patients With Critical Limb Ischemia

Tibioperoneal Angioplasty and Bypass

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