When is a technically successful peripheral angioplasty effective in preventing above‐the‐ankle amputation in diabetic patients with critical limb ischaemia?

Faglia, Ezio; Clerici, Giacomo; Clerissi, J; Mantero, Manuela; Caminiti, Maurizio; Quarantiello, Antonella; Curci, Vincenzo; Lupattelli, Tommaso; Morabito, Alberto

doi:10.1111/j.1464-5491.2007.02167.x

Cited by 91 publications

(61 citation statements)

References 28 publications

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“…It is equally clear, however, that it is irrelevant to major amputation: at 30 days none of the patients with CLI needed major amputation, and also in the longer follow-up the percentages of participants requiring major amputation were equal. This confirms that revascularisation of at least one artery of the foot is effective in avoiding major amputation in the neuropathic patient [28]. Therefore, both Goldenberg et al [25] and LoGerfo and Coffman [24] were right: Goldenberg et al actually saw arteriolar occlusive disease and LoGerfo and Coffman showed that revascularisation was effective in preventing amputation.…”

Section: Discussionmentioning

confidence: 51%

Prospective study on microangiopathy in type 2 diabetic foot ulcer

et al. 2016

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Aims/hypothesis We investigated the significance of microangiopathy in the development of foot ulcer, which is still disputed. Methods We assessed microangiopathy by histological analysis of the capillary ultrastructure using transmission electron microscopy and capillary density and arteriolar morphology in paraffin-embedded sections from the skin of type 2 diabetic patients: 30 neuroischaemic patients (Isc) revascularised with peripheral angioplasty and 30 neuropathic patients (Neu) with foot ulcer, compared with ten non-diabetic volunteers. Results In the diabetic patients, capillaries in the dermal papillary layer were fewer (−22.2%, 159 ± 43 vs 205 ± 52 mm 2 in non-diabetic volunteers, p < 0.01). They also showed detrimental remodelling, with a 2.2-fold increase in capillary basement membrane thickness (3.44 ± 1.19 vs 1.53 ± 0.34 μm in non-diabetic volunteers, p < 0.001) and a 57.7% decrease in lumen area (14.6 ± 11.1 vs 34.7 ± 27.5 μm 2 , p < 0.001). No differences were observed between the diabetic Isc or Neu patients. Isc were more prone to develop arteriolar occlusion than Neu (16.8 ± 6.9% vs 6.7 ± 3.7%, respectively, p < 0.001).No patient had been amputated at 30 days and healing time was significantly longer in Isc (180 ± 120 vs 64 ± 50 days in Neu, p < 0.001). Conclusions/interpretation Capillary microangiopathy is present in equal measure in neuroischaemic and neuropathic diabetic foot skin. The predominance of arteriolar occlusions with neuroischaemia indicated the existence of an additional 'small vessel disease' that did not affect an effective revascularisation and did not worsen the prognosis of major amputations but slowed the healing process of the neuroischaemic foot ulcer. Trial registration: ClinicalTrials.gov NCT02610036.

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Section: Discussionmentioning

confidence: 51%

Prospective study on microangiopathy in type 2 diabetic foot ulcer

et al. 2016

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“…PTA has established itself as a first-line treatment for CLI in patients with diabetic foot, with similar results to surgery in terms of limb salvage and patency [8][9][10]. The main studies in the literature [13,16,[23][24][25][26][27][28][29][30] reported, for endovascular treatment, a technical success rate of about 90 %, a negligible mortality rate, and a limb salvage rate at 3-5 years of 72-98 %.…”

Section: Discussionmentioning

confidence: 99%

“…The primary goal of PTA treatment is to restore the patency of at least one below-the-knee (BTK) vessel, preferably the tributary of the anatomical region of the ulcer [9]. Several studies have demonstrated good results in terms of patency and limb salvage after endovascular treatment of diabetic foot [10][11][12][13][14].…”

Section: Introductionmentioning

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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“…They introduced a simple concept: one patent vessel could be enough, but two patent vessels are better than one and three patent vessels are better than two. Moreover, the patency of the tibial vessels seems to be more important than that of the peroneal artery [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…Endovascular therapy with drug-eluting devices has recently been gaining more and more success in different vascular districts as well as in the below-the-knee region [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of infrapopliteal arteries: angioplasty vs stent in the drug-eluting era

Fanelli

Cannavale

2014

Eur Radiol

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To analyse data comparing drug-eluting devices versus non-coated devices in the treatment of vascular disease in the infrapopliteal region. All data available in the literature (16 studies were included) comparing drug-eluting stents (DESs) and drug-eluting balloons (DEBs) versus bare-metal stents (BMSs) and conventional balloons were analysed. For each single study, primary and secondary endpoints were reported. As comparative studies between DEBs and DESs were not available, a technical evaluation of the advantages and disadvantages of both were also included. Besides the limitations of the published studies, all of them were reporting interesting results for the new generation devices (DEB and DES). DES: primary patency at 1 year comprised between 75.0 % and 86 %; target lesion revascularisation between 8.7 % and 13.8 %. DEB: primary patency comprised between 71 % and 84.6 % at 12 months; target lesion revascularisation between 15.3 % and 17.6 %. However, limb salvage rates were not always higher using a DEB rather than a standard percutaneous transluminal angioplasty (PTA); a clinical improvement for patients treated with DEB was demonstrated only in the Leipzig registry. On the basis of the results available, the drug-eluting devices produced better results. DEB can be considered the leading approach in below-the-knee disease. A comparative evaluation with DES is mandatory in the future. Key Points • We present data about advanced endovascular treatment of peripheral artery disease.• This provides an update on drug-eluting devices in infrapopliteal vascular disease.• Drug-eluting devices (DEB/DES) show promising results compared with traditional ones.Abbreviations BMS bare-metal stent DEB drug-eluting balloon DES drug-eluting stent PTA percutaneous transluminal angioplasty SFA superficial femoral artery

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When is a technically successful peripheral angioplasty effective in preventing above‐the‐ankle amputation in diabetic patients with critical limb ischaemia?

Abstract: In patients with diabetes, PTA is effective in avoiding major amputation, provided recanalization occurs in at least one tibial artery down to the foot. In a few patients, re-canalization of the peroneal artery alone is not sufficient to avoid major amputation.

Cited by 91 publications

References 28 publications

Prospective study on microangiopathy in type 2 diabetic foot ulcer

Prospective study on microangiopathy in type 2 diabetic foot ulcer

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

Endovascular treatment of infrapopliteal arteries: angioplasty vs stent in the drug-eluting era

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