| Infrapopliteal balloon angioplasty for chronic critical limb ischemia in diabetic patients with uremia: when is it worth the effort? | |
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MedLine Citation:
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PMID: 19157896 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To assess the utility of infrapopliteal percutaneous transluminal angioplasty (PTA) in diabetic patients with end-stage renal disease and chronic critical limb ischemia. MATERIALS AND METHODS: Between 1994 and 2003, 20 consecutive diabetic patients with uremia (mean age, 59 years; age range, 39-73 years) underwent infrapopliteal PTA (total of 26 limbs). Additional infrainguinal lesions were treated in 12 limbs. Three limbs (12%) were classified as having Rutherford category 4 ischemia, 19 (73%) as having category 5 ischemia, and four (15%) as having category 6 ischemia. The mean length of the 58 treated infrapopliteal lesions was 8.8 cm. RESULTS: Angiographic success (<30% residual stenosis) was achieved in 22 of the 26 limbs (85%) and primary clinical success (at least one Rutherford category improvement) was achieved in nine (35%). One major complication was encountered. PTA was successful in producing a patent artery to the ankle level in 18 limbs. Primary clinical success was achieved in eight of those 18 limbs (44%) versus only one of the eight limbs (13%) with no patent artery after angioplasty (P = .01). When including the four repeated interventions, the clinical patency at 1 year (based on physical findings) was 38% (10 of 26 limbs). The rate of major amputations at 3, 6, and 12 months was 23%, 31%, and 35%, respectively, with a tendency of increased frequency among patients treated for more severe ischemia (Rutherford 4 vs 5 vs 6, P = .10). CONCLUSIONS: In diabetic patients with uremia, infrapopliteal PTA should be restricted to limbs without extensive tissue loss with lesions estimated to facilitate accomplishment of at least one patent artery to the ankle level. |
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Authors:
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Janne Kuusela; Hannu I Manninen; Pauli Karhapää |
Publication Detail:
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Type: Clinical Trial; Journal Article Date: 2009-01-21 |
Journal Detail:
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Title: Journal of vascular and interventional radiology : JVIR Volume: 20 ISSN: 1535-7732 ISO Abbreviation: J Vasc Interv Radiol Publication Date: 2009 Mar |
Date Detail:
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Created Date: 2009-03-02 Completed Date: 2009-06-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9203369 Medline TA: J Vasc Interv Radiol Country: United States |
Other Details:
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Languages: eng Pagination: 342-6 Citation Subset: IM |
Affiliation:
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Department of Clinical Radiology, Kuopio University Hospital, Kuopio University, Kuopio, Finland. janne.kuusela@kuh.fi |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Angioplasty, Balloon / methods* Diabetic Angiopathies / surgery* Female Humans Ischemia / complications*, surgery* Leg / blood supply*, surgery Male Middle Aged Patient Satisfaction Popliteal Artery / surgery* Retrospective Studies Treatment Outcome Uremia / complications*, surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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