PTA Versus Carbofilm-Coated Stents in Infrapopliteal Arteries: Pilot Study

Purpose: To determine the primary success and short-term patency of stent application as a primary treatment modality for high-grade lesions of the infrapopliteal arteries compared with treatment with percutaneous transluminal angioplasty (PTA) in critical limb ischemia in a randomized prospective study. Methods: Endovascular therapy was performed on 95 lesions in 51 patients (mean age 72.0 years, range 47–80 years) who presented clinically with Fontaine stages III and IV. One patient underwent treatment in both limbs. After angiographic lesion identification, patients were randomized for treatment by PTA (53 lesions in 27 patients) or stent application (42 lesions in 24 patients). Follow-up by clinical investigation and conventional angiography or spiral CT angiography was performed in 37 patients (57 lesions) 6 to 12 months after the procedure, or when clinically indicated. Evaluation was performed by two observers, double-blinded, with thresholds for lesion restenosis of 50% and 70%. Statistical evaluation was performed on a lesion basis by Kaplan–Meier estimated probability rates, and log-rank and Wilcoxon tests. The primary endpoint was the angiographic patency rate of treated lesions. Results: The inter-reader agreement was high (κ = 0.82). For the stent group the cumulative primary patency at 6 months was 83.7% at the 70% restenosis threshold, and 79.7% at the 50% restenosis threshold. For PTA, the primary patency at 6 months was 61.1% at the 70% restenosis threshold and 45.6% at the 50% restenosis threshold. Both results were statistically significant (p < 0.05). Conclusion: Infrapopliteal stent application is an effective treatment modality for high-grade lesions in chronic critical limb ischemia. Compared with PTA, higher patency rates can be expected after 6 months.     

Infrapopliteal application of paclitaxel-eluting stents for critical limb ischemia: midterm angiographic and clinical results

PURPOSE: To report the midterm (30%, or flow-limiting dissection). Patients were followed up with regular clinical evaluation, and digital subtraction angiography was scheduled at 6 months and 1 year. Life-table analysis and Kaplan-Meier plotting of angiographic and clinical variables were performed. Cox proportional-hazards regression analysis was employed to adjust for various covariates and search for independent adverse predictors of angiographic and clinical outcome. RESULTS: Infrapopliteal procedures were performed in 29 patients with 32 limbs with CLI; 79.3% of the patients had diabetes and 34.5% had renal disease. A total of 62 coronary PES were deployed in 50 below-knee lesions (mean stent-implanted length, 25.51 mm+/-12.16). Technical success rate was 100%. The 1-year mortality rate was 16.9%, and the limb salvage rate was 88.5%. The 1-year angiographic in-stent primary patency rate was 30.0%, whereas the incidence of in-stent binary (>50%) restenosis was 77.4%. The 1-year incidence of clinically driven repeat interventions was 30.5%. The Cox model calculated renal disease as the only independent predictor of decreased primary patency and increased repeat intervention events. Initial occlusions also adversely affected primary patency. CONCLUSIONS: Infrapopliteal PES achieved acceptable clinical results in CLI, even though they failed to inhibit vascular restenosis and decrease the need for repeat interventions. Renal disease and initial occlusions are adverse prognostic factors for infrapopliteal endovascular procedures.     

Initial clinical experience with the 4-F self-expanding XPERT stent system for infrapopliteal treatment of patients with severe claudication and critical limb ischemia

PURPOSE: To evaluate the primary success and short-term patency associated with a new 4-F sheath-compatible self-expanding nitinol stent after failed conventional angioplasty of distal popliteal and infrapopliteal lesions in severe lifestyle-limiting claudication (LLC) and chronic critical limb ischemia (CLI). MATERIALS AND METHODS: Between May 2003 and July 2005, 35 patients with Rutherford category 3-5 disease (16 patients with CLI, 19 patients with LLC) underwent percutaneous transluminal angioplasty (PTA) and stent implantation. Indications for stent placement were residual stenosis, flow-limiting dissections, or elastic recoil after PTA. Before and after the intervention and during the 6-month follow-up, clinical investigation, color-flow and duplex Doppler ultrasonography, and digital subtraction angiography were performed. Technical success, primary patency at 6 months, clinical improvement as defined by Rutherford with clinical and hemodynamic measures, and complications were evaluated. RESULTS: A total of 22 patients underwent distal popliteal artery stent placement and 13 underwent tibioperoneal artery stent placement. Stent implantation was successfully performed in all patients. After stent placement, the primary cumulative patency rate for the study group at 6 months was 82%. The mean resting ankle-brachial index at baseline was 0.50 +/- 0.16 and significantly increased to 0.90 +/- 0.17 at 12-24 hours after intervention and 0.82 +/- 0.24 at latest follow-up (P < .001 for both). The sustained clinical improvement rate was 80% at the 6-month follow-up. The 6-month limb salvage rate regarding major amputation was 100%. The rate of major complications was 17%. CONCLUSIONS: Infrapopliteal application of the new nitinol stent is a safe, feasible, and effective method with good short-term patency rate in the treatment of severe LLC and chronic CLI.     

长球囊治疗重症下肢动脉缺血性病变的近期疗效观察

目的观察长球囊治疗重症下肢动脉缺血性病变的可行性和近期效果。方法对2007年1至6月收治的21例重症下肢缺血患者,根据病变范围,选择合适长度的球囊对狭窄或闭塞性病变进行球囊扩张成形,相临近多处短段病变也尽可能采用长球囊一次成形;观察术中及术后患者的并发症发生率、技术成功率和临床疗效;通过随访,判断治疗的初始通畅率、再次通畅率、救肢率和生存率。结果21例患者早期技术性的并发症2例(9.5%),均为穿刺点假性动脉瘤。狭窄性病变的技术成功率100%;股、腘动脉闭塞性病变再通的总的成功率为88.9%,其中采用内膜下成形(5例)技术成功4例;胫前动脉、胫后动脉和腓动脉闭塞性病变的技术成功率分别为55.6%、28.6%和25.0%。未出现影响血流的夹层。临床成功率为90.5%。术后平均住院时间6 d。术后6个月的初始通畅率为95.2%;再次通畅率和救肢率均为100%。结论对于重症下肢动脉缺血性病变患者,长球囊PTA后无影响血流的夹层瘤出现,初始技术和临床成功率都很高,是安全、有效的治疗重症下肢动脉缺血性病变的方法。     

Endovascular Management of the Arteria Profunda Femoralis: Long-Term Angiographic and Clinical Outcomes

Purpose

This study was designed to investigate the long-term angiographic and clinical outcomes of percutaneous transluminal angioplasty (PTA) of the arteria profunda femoralis (PFA), in a series of patients suffering from critical limb ischemia (CLI) or severe intermittent claudication (IC).

Methods

Our department’s database was searched to identify patients who underwent PTA or bail-out stenting of the PFA. Among the study’s inclusion criteria were Rutherford categories 3–6 and?≥70% stenosis of the PFA. Only de novo stenotic lesions were assessed. Primary endpoints were technical success, angiographic lesion primary patency, angiographic binary in-lesion restenosis, and target lesion recanalization (TLR) rates. Secondary endpoints included patient survival, limb salvage, and complication rates. Patient’s baseline demographics, lesion, and procedural details were analyzed.

Results

Between 2001 and 2011, 20 consecutive patients (17 males) with a mean age of 73?±?9 (range 53–87) years underwent PTA or bail-out stenting in 23 PFA lesions. Critical limb ischemia was the indication in eight of 20 patients (40%). The mean lesion length was 31?±?9.5?mm. The procedural technical success was 100% (23/23), whereas mean time angiographic and clinical follow-up was 26.8?±?24.6?months. According to the Kaplan–Meier analysis, primary patency and binary restenosis rate were 95 and 86.1% respectively up to 8?years follow-up. No TLR procedures were performed. The 8-year patient survival and limb salvage rates were 87.5 and 84.7% respectively.

Conclusions

PTA or stenting of focal, stenotic, PFA lesions, in patients suffering from CLI or IC, exhibit high long-term primary patency rates, as well as low binary restenosis and TLR rates. Large, multicenter studies are required to validate these results.     

PTA versus Palmaz stent placement in femoropopliteal artery obstructions: a multicenter prospective randomized study

PURPOSE: To evaluate if stent placement is superior to percutaneous transluminal angioplasty (PTA) in the treatment of chronic symptoms in short femoropopliteal arterial lesions. MATERIALS AND METHODS: One hundred fifty-four limbs in 141 patients who ranged in age from 39 to 87 years (mean age, 67 years) were randomized to PTA (n = 77) versus PTA followed by implantation of Palmaz stents (n = 77). Inclusion criteria were patients with intermittent claudication (n = 108, Society of Vascular Surgery/International Society of Cardiovascular Surgery [SVS-ISCVS] categories 1-3) or chronic critical limb ischemia (n = 46 with either ischemic rest pain [category 4] or minor tissue loss [category 5]), short stenosis or occlusion (lesion length < or = 5 cm), and at least one patent run-off vessel at angiography. Follow-up included clinical assessment, measurement of ankle/ brachial index (ABI), color duplex ultrasound, and/or angiography at 6 or 12 months. Angiographic follow-up between 12 and 36 months was available in 46 limbs (29.9%). RESULTS: In the PTA group, initial technical success was achieved in 65 of 77 limbs (84%) versus 76 of 77 (99%) limbs in the stent group (chi2 value = 0.009). Overall, major complications occurred in 3.9% (n = 6); n = 4 in the PTA group compared to n = 2 in the stent group. There was no difference between groups of treatment: hemodynamic/clinical success at 1 and 2 years in the PTA group was 72% and 65% versus 77% and 65% in the stent group (Gehan P value = .26). The cumulative 1- and 2-year angiographic primary patency rates were 63% and 53%, respectively, for both groups. The secondary 1- and 2-year angiographic patency rates were 86% and 74% in the PTA group versus 79% and 73% in the stent group (P = .5). CONCLUSION: After stent placement, the primary success rate was significantly higher than after PTA. However, 1-year angiographic and clinical/hemodynamic success was not improved.     

The use of below-knee percutaneous transluminal angioplasty in arterial occlusive disease causing chronic critical limb ischemia

Purpose To determine the efficacy, safety and long-term results of crural artery percutaneous transluminal angioplasty (PTA) in limbs with chronic critical limb ischemia (CLI). Methods Patients undergoing crural artery PTA due to CLI were followed at regular clinic visits with ankle brachial pressure index (ABPI) measurements. PTA of the crural arteries was attempted either alone (n=39) or in combination with PTA of the superficial and/or popliteal artery (n=55) in 86 limbs (82 patients and 94 procedures) presenting with CLI. The ages of patients ranged from 37 to 94 years (mean 72 years). The indications for PTA were rest pain in 10 and ulcer/gangrene in 84 limbs. Results A technically successful PTA with at least one crural level was achieved in 88% of cases (n=83). Cumulative primary clinical success rates at 6, 12, 24, and 36 months were 55%, 51%, 36%, and 36%, respectively. Cumulative secondary clinical success and limb salvage rates at 36 months were 44% and 72%, respectively. Conclusion PTA of the crural arteries might be considered the primary choice of treatment in patients with CLI and distal lesions with localized stenosis or segmental short occlusions.     

Infrapopliteal percutaneous transluminal angioplasty for limb salvage

Purpose:
To evaluate long-term results of infrapopliteal percutaneous transluminal angioplasty (PTA) for limb salvage.
Material and Methods:
A retrospective study of 71 consecutive infrapopliteal PTAs in 49 patients with rest pain (n=20) or ulceration (n=29) was conducted. In 18 patients, surgical minor amputation or debridment was also performed.
Results:
Technical success was achieved in 45 patients. Four failures necessitated 2 amputations. One patient died in the postoperative course. Global morbidity rate was 16%, including minor complications in 5 patients and major vascular complications in 3 patients. After technical success during the follow-up (median duration 21 months), restenoses occurred in 4 patients, of whom 3 had a successfull re-PTA (clinical success rate 72%). Survival, primary patency, secondary patency and limb salvage rates were, respectively, 75%, 81%, 88% and 87% after 3 years. The only positive predictive factor for primary patency was the presence of diabetes mellitus.
Conclusion:
Infrapopliteal PTA is a safe and effective procedure, allowing good patency and limb salvage rates with low mortality and morbidity.     

Percutaneous transluminal angioplasty of infrapopliteal vessels: preliminary results and technical considerations

Infrapopliteal balloon angioplasty was performed in 11 patients facing reconstructive surgery for limb salvage. Twelve separate sessions of angioplasty were performed, during which 15 of 16 diseased tibial runoff vessels were successfully dilated. Three complications occurred during percutaneous transluminal angioplasty (PTA). One was related to the concomitant use of a thrombolytic agent to open a femoropopliteal bypass graft and not related to the angioplasty itself. No limbs were lost as a result of complications. The procedure was a technical success in nine of 12 cases (75%) and an initial clinical success in eight of the nine that were technically successful (89%). Follow-up ranged from 1 to 22 months. Six of the nine cases (67%) remained clinically successful during this period. Preliminary results suggest that infrapopliteal PTA is a safe and effective alternative to surgical reconstruction in selected patients.     

The final outcome of primary infrainguinal percutaneous transluminal angioplasty in 100 consecutive patients with chronic critical limb ischemia

PURPOSE: This study was performed to determine final outcomes in patients treated with infrainguinal percutaneous transluminal angioplasty (PTA) for chronic critical limb ischemia (CLI). MATERIALS AND METHODS: The study population consisted of 100 consecutive patients (mean age, 72 y; range, 38-90 y; 40 men and 60 women) with 116 treated limbs. CLI was defined as rest pain or ischemic tissue defect combined with an ankle systolic pressure < or = 50 mm Hg. Indication for treatment was rest pain in 23 limbs (20%), ischemic ulcer in 50 (43%), and gangrene in 43 (37%). All patients were followed until they had met the study endpoints: major amputation or death. The mean follow-up period was 38 months (1-119 mo). Limb salvage, survival, and life with limb rates were determined along with their determinants. RESULTS: On average, 1.9 invasive procedures were required during the lifespan of a critically ischemic limb, including primary PTA and 32 repeat PTA procedures, 11 surgical revascularizations, and 51 amputations. The major amputation rate was 32% (n = 37). Limb salvage for endovascular treatments at 3, 5, and 8 years was 65%, 60%, and 60%, respectively (SE of estimate [SEE] 相似文献   

Distal popliteal and tibioperoneal transluminal angioplasty: long-term follow-up.

The long-term efficacy of percutaneous transluminal angioplasty (PTA) for treatment of occlusive lesions involving arteries below the knee was evaluated in 168 consecutive patients. The procedure was preceded by intraarterial thrombolysis in 33 patients with failing femorodistal grafts. Indications were disabling claudication in 40 cases (24%), acute ischemia in 18 (11%), rest pain in 49 (29%), and tissue necrosis in 61 (36%). Angioplasty of tandem femoral and/or iliac lesions was performed in 58 cases (34.5%). Major complications were observed in 19 patients (11.3%) and minor complications in 12 others. Five patients died within 30 days (3%). Mean follow-up was 26.1 months (range, 4-72 months). Major amputation was required in 26 cases (15%). The cumulative clinical success at 3 years was 83% for a single stenosis, 76% for multilevel lesions, 44% following lytic therapy, 36% for segmental occlusions, and 14% for anastomotic stenoses. Infrapopliteal PTA is useful in selected patients. Factors associated with poor long-term patency include a single patent tibial artery (P = .039), acute ischemia (P = .03), anastomotic stenosis (P = .01), and, possibly, complete occlusion prior to treatment (P = .091).     

Balloon angioplasty of popliteal and crural arteries in elderly with critical chronic limb ischemia

OBJECTIVE: Elderly patients with extensive infrainguinal peripheral vascular disease and critical chronic limb ischemia (CCLI) are poor surgical candidates. Our purpose was to evaluate angiographic and clinical results of popliteal, infrapopliteal, and multi-level disease percutaneous transluminal angioplasty (PTA) in such patients. DESIGN: Retrospective study of angiographic and clinical files in selected group. MATERIALS AND METHODS: Between 1996 and 2002, 38 elderly patients aged 80-94 years old (mean age 83.3) with critical leg ischemia were treated with PTA. All patients were at high surgical risk. 31/38 (81.5%) patients had chronic non-healing wounds, and 14/38 (37%) had multi-level disease of superficial femoral, popliteal and crural arteries. One hundred and two lesions were treated by angioplasty. Immediate angiographic and 1 year clinical results were retrospectively analyzed. RESULTS: The overall procedural success rate was 32/38 (84.2%). There were three major complications (7.9%), but no deaths, and three technical failures, all were of infrapopliteal lesions. After 1 year, 27 patients could be followed, five patients died during the first year of unrelated causes. Twenty-three patients (85.2%), were clinically re-occluded within 1 year, but complete and partial wound healing was achieved in 80% (16/20) and rest pain improvement in 57% (4/7), so that overall limb salvage was 74% (20/27). CONCLUSIONS: Elderly patients with multi-level CCLI have a short patency term following angioplasty of 14.8% after 1 year. Nevertheless, this temporary vascular patency enables wound healing or improvement in 74% of these patients, thus such endovascular interventions are recommended in this age group.     

经皮腔内血管成形术治疗膝下动脉硬化闭塞症的临床分析

目的探讨经皮腔内血管成形术（percutaneous transluminal angioplasty,PTA）对膝下动脉硬化闭塞症的治疗效果。方法回顾性分析我院从2006年10月-2009年2月采用PTA治疗膝下动脉硬化闭塞症的32例患者（42条肢体）的病史资料和术后随访资料。结果39条肢体获得影像学成功（残余狭窄率〈30％）,技术成功率为92．9％（39／42）,治疗后第1周踝／肱指数（ABI）由术前的0．44＋0．12增至0．82＋0．20,术后6、12个月肢体通畅率分别为为85．7％（36／42）和71．4％（30／42）,术后12个月肢体保全率和存活率分别为92．9％（39／42）和93．8％（30／32）。结论PTA治疗膝下动脉硬化闭塞症的临床成功率高、并发症少、救肢率高,是安全有效的治疗膝下动脉硬化闭塞症的方法。     

Primary Infrainguinal Subintimal Angioplasty in Diabetic Patients

The aim of this study was to prospectively evaluate technical and clinical results of infrainguinal subintimal angioplasty in a series of diabetic patients with limb-threatening ischemia. From July 2003 to December 2007, 60 consecutive diabetic patients (M/F = 41/19; mean age, 69.4 ± 9.4 years) with Fontaine stage IV critical limb ischemia, not suitable for surgical recanalization, underwent primary infrainguinal subintimal angioplasty. The technical success, perioperative morbidity and mortality, and clinical success (defined by ulcer healing) were evaluated. Kaplan–Meier life-table analysis was obtained for cumulative clinical success, limb salvage, and survival rates. The procedure was technically successful in 55 of 60 (91.7%) patients; in 5 cases we were not able to achieve a reentry. Periprocedural mortality was 5% (3 patients); three patients (5%) required major amputation periprocedurally. Mean follow-up was 23 months (range, 0–48 months). On an intention-to-treat basis, the limb salvage rate was 93.3% (56/60 patients); ulcer healing was observed in 45 of 60 (75%) patients and it was significantly (p < 0.05) associated with serum creatinine and HbA1c levels, diabetes duration, and infrapopliteal recanalization. One- and three-year cumulative survival rates were 91.5% and 83.1%, respectively; serum creatinine levels, patient age, and clinical success were significant predictors of survival. In conclusion, infrainguinal primary subintimal angioplasty is a safe and effective treatment in diabetic patients with limb-threatening ischemia not suitable for surgical recanalization. This procedure is aimed to create a “temporary bypass” that facilitates ulcer healing.     

Percutaneous transluminal angioplasty of the popliteal artery and its branches

Percutaneous transluminal angioplasty (PTA) of the popliteal artery and its branches was performed for relief of ischemia of the leg. Thirty-four procedures were performed in 31 patients (bilateral in 1 and repeated in 2). Angioplasty was technically successful in 29 cases (85%), with immediate clinical improvement in 26 (89%). The mean ankle-arm pressure index rose from 0.28 to 0.77. Long-term noninvasive follow-up in 23 of 26 patients with initial clinical improvement demonstrated reocclusion in 6 (2 of whom had successful redilatation) and continued patency in 13 who were followed up for 3 to 29 months (average, 11.6 mo.); the mean ankle-arm pressure index was 0.71 and the cumulative patency rate at 2 years was 57%. Six patients died, though all were asymptomatic. Since many of these procedures are performed for limb salvage in patients who would not benefit from surgery, PTA is useful in providing acute and often prolonged relief of ischaemia of the leg.     

Percutaneous transluminal angioplasty for Brescia-Cimino hemodialysis fistula dysfunction: technical success rate, patency rate and factors that influence the results

OBJECTIVE: To evaluate the initial clinical success and long-term patency rates of percutaneous transluminal angioplasty (PTA) using a venous approach for dysfunctional Brescia-Cimino fistula and to identify factors that may affect initial success and long-term patency. MATERIALS AND METHODS: A total of 99 PTA procedures were performed in retrograde fassion for 60 mature Brescia-Cimino shunts with dysfunction caused by anastomotic or peripheral outflow vein stenosis or occlusion. The initial clinical success rates were compared between stenosis and occlusion using Fisher's exact test. The Kaplan-Meier method was used to calculate the primary and secondary cumulative patency rates, and the log-rank test was used for comparison. Relative risks of patency loss according to clinical characteristics were determined with multivariate Cox models. Results: The initial clinical success rate of all interventions was 92%, and the rates for stenosis and occlusion were 99 and 65%, respectively (P < 0.0001). The primary and secondary cumulative patency rates for fistulas (excluding initial failure) at 12 months were 53 and 84%, respectively. The relative risks were 5.2 (P = 0.004) for longer lesions and 4.5 (P = 0.007) for younger fistulas. The primary cumulative patency rate of four patients with a younger fistula and a longer stenosis at 4 months was 0%. CONCLUSION: Favorable primary and secondary cumulative patency rates are obtained in most patients. Long lesion length and younger age of fistulas were the two factors that reduced the patency rate after PTA.     

Randomized, multicenter study comparing expanded polytetrafluoroethylene-covered endoprosthesis placement with percutaneous transluminal angioplasty in the treatment of superficial femoral artery occlusive disease

PURPOSE: To compare the safety and effectiveness of the Viabahn endoprosthesis with that of percutaneous transluminal angioplasty (PTA) alone in the treatment of symptomatic peripheral arterial disease (PAD) affecting the superficial femoral artery (SFA). MATERIALS AND METHODS: From 1998 to 1999, patients with symptomatic SFA PAD were enrolled in a prospective, multicenter randomized study and underwent either PTA alone (n = 100) or PTA followed by stent-graft placement (expanded polytetrafluoroethylene/nitinol self-expanding stent-graft) (n = 97) for stenoses or occlusions of the SFA that were 13 cm long or shorter. At baseline, there were no significant differences between the PTA and stent-graft treatment groups, including chronic limb ischemia status and treated lesion length. RESULTS: The stent-graft group had a significantly higher technical success rate (95% vs 66%, P < .0001) and 1-year primary vessel patency rate at duplex ultrasonography (65% vs 40%, P = .0003). A patency benefit was seen for lesions at least 3 cm long. At 12 months, chronic limb ischemia status was 15% further improved for the stent-graft group (P = .003). There were no significant differences between treatment groups with regard to the occurrence of early or late major adverse events. CONCLUSIONS: In this multicenter study, the patency, technical success, and clinical status results obtained with stent-grafts were superior to those obtained with PTA alone.     

Percutaneous transluminal angioplasty of peripheral bypass stenoses

Purpose: To assess the success of percutaneous transluminal angioplasty (PTA) in treating peripheral bypass stenoses. Methods: Patients who received a femoropopliteal or femorocrural bypass graft for limb ischemia were included in a duplex surveillance program. If duplex ultrasound revealed a short (<2 cm) severe (peak systolic velocity ratio ≥ 4.5) stenosis, patients were scheduled for arteriography and PTA. Fifty-eight peripheral bypass stenoses in 39 grafts in 37 patients were treated with PTA. The cumulative primary patency of treated stenoses was calculated. Results: During the first year after PTA 31 (53%) treated lesions remained patent, 15 (26%) lesions restenosed at a median interval of 5.0 (range 1–12) months and 4 (7%) bypasses occluded. The cumulative primary patency of 58 treated graft stenoses at 1 year was 60% [95% confidence interval (CI) 46%–74%] and 55% (95% CI 41%–70%) at 2 years. Graft body stenoses showed a better 2-year cumulative primary patency (86%; 95% CI 68%–100%) compared with juxta-anastomotic lesions (45%; 95% CI 29%–62%; p < 0.05). Conclusion: PTA is justifiable as the initial treatment of peripheral bypass stenoses. Nevertheless, the restenosis rate is rather high, especially in juxta-anastomotic lesions. Continuation of duplex surveillance after PTA and timely reintervention is recommended.     

Infra-inguinal percutaneous transluminal angioplasty for limb salvage: a retrospective analysis in a single center

PURPOSE: To review the feasibility of infra-inguinal angioplasty in the management of critical limb ischemia (CLI). MATERIAL AND METHODS: Data on 221 patients with 230 critically ischemic limbs, treated with consecutive percutaneous transluminal angioplasty (PTA) at Helsinki University Central Hospital between January 2000 and December 2002 were collected and analyzed retrospectively. Patency, limb salvage, and survival rates were calculated on an intention-to-treat basis. Comparisons were done with univariate (Kaplan-Meier) and multivariate analysis (Cox regression). RESULTS: Overall primary patency, secondary patency, limb salvage, and survival rates were 47%, 59%, 92%, and 76%, respectively, at 12 months. In the multivariate analysis, low toe pressure (< or =30 mmHg) was a significant risk factor for poor patency. Uremia with hemodialysis, low toe pressure (< or =30 mmHg), and hemodynamic failure of the endovascular procedure were found to increase significantly the risk of amputation. Uremia with hemodialysis, coronary artery disease, tissue loss as indication for PTA (Fontaine stage IV), and age over 70 years were all found to increase significantly the risk of death. CONCLUSION: Infra-inguinal PTA is feasible in patients with CLI and resulted in good limb salvage.     

Percutaneous management of chronic mesenteric ischemia: outcomes after intervention

PURPOSE: To assess the efficacy and durability of percutaneous transluminal angioplasty (PTA)/stent placement for treatment of chronic mesenteric ischemia (CMI). MATERIALS AND METHODS: A retrospective review of patients treated from January 1986 to August 2003 was conducted. Twenty-nine patients (mean age, 62 years) were treated for clinical symptoms consistent with CMI. Clinical diagnosis was verified with angiographic assessment and PTA with or without stent placement was performed based on angiographic and/or pressure gradient findings. Outcomes were estimated with the Kaplan-Meier method. RESULTS: A total of 63 interventions were performed in 29 patients during the study period. Of these 63 interventions, 46 PTA and 17 stent implantation procedures were performed. Thirty-four interventions were performed for SMA stenosis/occlusion, 17 interventions for celiac artery stenosis/occlusion, and four interventions were performed on aorto-mesenteric graft stenoses. Technical success was 97%, and clinical success (defined as clinical resolution of symptoms) was 90% (26 of 29 patients). Mean duration of follow-up was 28.3 months. Primary patency for all interventions at 3, 6, and 12 months was 82.7% (95% CI: 68.7-96.7), 78.9% (66.7-91.1), and 70.1% (55.1-85.6), respectively. Primary assisted patency for all interventions at 3, 6, and 12 months was 87.9% (79.0-95.3), 87.9% (79.2-95.1), and 87.9% (77.3-98.3), respectively. An average of 1.9 interventions per patient was required. One major complication occurred (3.4%). There were three minor complications (10.3%). CONCLUSIONS: Percutaneous intervention for CMI is safe with durable early and midterm clinical success. However, repeated intervention is often required for improved primary assisted patency.