Limb Salvage after Infrapopliteal Angioplasty for Critical Limb Ischemia in Surgically High-Risk Patients in Iran

INTRODUCTION: Surgical bypass for the treatment of lower extremity peripheral arterial disease is a suboptimal option in high-risk surgical patients or patients with limited life expectancy. Percutaneous transluminal angioplasty (PTA) is an alternative in such patients; however, the results of this approach have not been wellstudied in our region. This study evaluated the results of infrapopliteal percutaneous transluminal angioplasty and/or stenting for critical limb ischemia (CLI) due to peripheral arterial disease of lower limbs in surgically high-risk patients. METHODS: We conducted a retrospective study in four medical centers in Iran, from May 2006 to September 2009. Patients with CLI (Rutherford category 4-6), multiple twovessel lesions, ankle-brachial index (ABI) of less than 0.05, high surgical risk category, and a follow-up of > 1 year after percutaneous transluminal angioplasty were included. Patients with restenosis of graft lesions, a life expectancy of less than 1 year, or those who were thienopyridine intolerant were excluded. “Limb salvage” was defined as a reduction in stenosis or occlusion to less than 30%. The primary endpoint was limb salvage rate. Survival and patency were evaluated with the Kaplan-Meier method. RESULTS: Sixty patients met the inclusion criteria. Mean age was 60.5±8.4 years (men 73.3%, diabetes mellitus 83.3%, current smoker 33.3%, hypertension 70%) and baseline ABI was 0.51±0.08. Anterior tibial artery (47%) was the most frequently involved blood vessel. A total of 22 stents and 122 balloon angioplasties were used in 98 limbs. “Limb salvage” was achieved in 58 (96.6%) patients immediately after the procedure. One-year salvage rate was 88.3%. Complete ulcer healing was achieved in 64.3% patients, and partial healing was obtained in 26.4%. Only one major procedure-related complication was reported; perforation with post-operative compartment syndrome. Major arterial access site complications (n=3, 5%) included two hematomas and a pseudoaneurysm. One-year survival rate was 96.6%. One-year major amputation rate was 11.7%. CONCLUSIONS: Infrapopliteal angioplasty alone or with stenting is a valuable treatment option for the prevention of amputations in patients with CLI for whom surgical bypass is not an option and in whom the risk of amputation is high. Conflicting Interest: None declared This article has been peer reviewed. Article Submitted on: 24 th April 2011 Article Accepted on: 28 th August 2011 Funding sources: None declared Correspondence to Javad Kojuri Address: Division of Cardiology, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran Email: [email protected] INTRODUCTION Atherosclerosis is a common cause of morbidity and mortality with a prevalence of 11.4% to 33.8% in individuals above 60 years of AgE [1, 2] The prevalence of intermittent claudication, a symptom of peripheral arterial atherosclerosis, is estimated to be present in 610% of the elderly population.