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Infrapopliteal angioplasty viable option for high-risk patients with critical limb ischemia, diabetes
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Infrapopliteal angioplasty was associated with positive outcomes in high-risk patients with critical limb ischemia and diabetes, according to recent study findings.
There is little consensus as to whether an endovascular-first or bypass-first strategy should be deployed in this patient population, according to the study background. In some patients, the researchers wrote, surgical bypass may be contraindicated because it requires general anesthesia.
The researchers investigated whether performing percutaneous transluminal angioplasty on high-risk (at least three major comorbidities) patients with diabetes, critical limb ischemia (CLI) and isolated infrapopliteal lesions is safe and feasible.
They performed a retrospective study of 101 high-risk patients (160 lesions) with diabetes, CLI and isolated infrapopliteal lesions who underwent infrapopliteal endovascular revascularization at a single center between 2008 and 2010.
The outcomes of interest were safety, technical success rate, healing rate, and the 1-year rates of overall survival, primary patency, secondary patency and limb salvage.
Anne-Catherine Lejay, MD, from the department of vascular surgery and kidney transplantation at the University Hospital of Strasbourg, France, and colleagues wrote that there were no major CV or cerebrovascular events at 30 days.
At 30 days, two patients had thromboses of the treated vessels and required major amputation, whereas seven had minor adverse events (three groin hematomas and four pulmonary infections), they wrote.
Other outcomes were as follows:
- technical success rate, 83%;
- healing rate, 78%;
- survival at 1 year, 86%;
- primary patency at 1 year, 67%;
- secondary patency at 1 year, 83%; and
- limb salvage at 1 year, 84%.
Between 30 days and 1 year, 12 patients required major amputation, 10 because of thrombosis in the treated artery and two because of poor progression of the wound despite patency in the treated artery.
“Endovascular surgery may now be considered a first-line treatment in [patients with CLI] presenting with morbidities,” Lejay and colleagues wrote. “It allows significant potential advantages of a low-invasive approach in these patients presenting with many comorbidities.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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