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| |  Below-Ankle Angioplasty for Critical Limb Ischaemia Yields Good Results: Presented at SIR By Thomas R. Collins TAMPA, Fla -- March 18, 2010 -- Below-the-ankle angioplasty for critical limb ischaemia (CLI) has yielded good results and helped preserve limbs at risk of being lost, researchers said here at the Society of Interventional Radiology (SIR) 35th Annual Scientific Meeting. Researchers from the Patras University Hospital, Patras, Greece, analysed results for patients who underwent infrapopliteal revascularisation procedures including angioplasty and bail-out stenting of the dorsalis pedis artery, the plantar artery, or both. They procedure was technically successful in 19 of 20 cases (95%). A total of 17 of the 19 limbs, in 17 patients, were able to be saved -- a rate of 89%. “Below-the-ankle angioplasty for CLI treatment is safe and feasible,” said Athanasios Diamantopoulos, MD, Patras University Hospital, at a presentation on March 15. “Balloon-expandable stents should be reserved for bail-out in exceptional cases because of a high risk of external compression.” One percent to two percent of all adults aged older than 50 years suffers from CLI. It primarily affects patients with diabetes and end-stage renal disease. Primary amputations are still a common CLI treatment. Studies have found that as many as 73% of patients without recanalisation after 1 year undergo amputation, with 95% having tissue loss. But the amputation rates have been found to fall to 25% at 1 year for those with recanalisation. “You can understand why recanalisation is very important in this high morbidity patient group,” Dr. Diamantopoulos said. In the study, 15 of the 17 patients were male, mean age was 73 years, and 14 had diabetes. The average stage on the Rutherford scale was 5. Eight of the 20 lesions were occluded and 15 of 20 were calcified. Eleven of the 20 lesions required bail-out stenting. There were 5 stent deformations -- 4 deformed stents and 1 severe fracture. They were associated with “significant vessel restenosis and/or occlusion,” Dr. Diamantopoulos said. The 2-year target lesion revascularisation rate was 15.2%, the primary patency rate was 45%, and the binary restenosis rate was 78.2%. There was no significant difference in these rates for stented and non-stented lesions. Dr. Diamantopoulos cautioned that there are risks involved with the procedure. “Guidewire-induced spasm or dissection or distal embolism or thrombosis is always a risk.” [Presentation title: Outflow Vessel Treatment During Infrapopliteal Endovascular Procedures: Long-Term Outcome of Below-The-Ankle Angioplasty and Stenting. Abstract 41]
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