Document Detail


Infrapopliteal run-off and the outcome of femoropopliteal percutaneous transluminal angioplasty.
MedLine Citation:
PMID:  20464672     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The outcome of percutaneous transluminal angioplasty (PTA) of peripheral arterial lesions is influenced by several factors, including the haemodynamic conditions. Our study tested: (a) whether infrapopliteal run-off after completed PTA influenced the time course of restenosis/reocclusion of the femoropopliteal arterial segment, and (b) whether worsening of infrapopliteal run-off influenced the long-term femoropopliteal patency after PTA.
PATIENTS AND METHODS: Among 245 patients treated by femoropopliteal PTA we enrolled 176 patients who consented to regular follow-up. Concomitant infrapopliteal PTA was performed whenever feasible. The technical success of PTA and the patency of calf arteries were assessed by angiography. Infrapopliteal run-off was scored by a modification of the Society for Vascular Surgery criteria. The treated patients' limbs were divided into a group with good infrapopliteal run-off and a group with compromised run-off. Follow-up examination of the femoropopliteal arterial segment was performed by vascular ultrasonography (US) 1, 6 and 12 months after PTA, and an adverse outcome was defined by a > or = 50 % stenosis, i.e., at least doubling of the maximal systolic velocity, or occlusion - evidenced by the absence of flow. The patency of calf arteries was re-assessed by US 12 months after PTA.
RESULTS: One month after femoropopliteal PTA 19 / 83 (23 %) of patients with compromised run-off developed the combined end-point of restenosis or reocclusion in comparison to 10 / 93 (11 %) with good run-off (p = 0.03). After 6 months the incidence of restenosis/reocclusion had increased in both groups at an approximately equal rate, but the differences were no longer significant: 39 / 80 (49 %) in the compromised run-off group vs. 36 / 83 (43 %) in the good run-off group after 6 months, p = 0.49, and 42 / 73 (57 %) vs. 38 / 73 (52 %) after 12 months, p = 0.51. However, in patients' limbs with good periprocedural run-off that deteriorated into compromised run-off in the year after PTA, femoropopliteal restenosis/reocclusion occurred more often than in limbs which retained good run-off: 10 / 14 (71 %) vs. 18 / 51 (35 %), p = 0.02.
CONCLUSIONS: Compromised postprocedural infrapopliteal run-off predisposes to early restenosis/reocclusion after femoropopliteal PTA. Deterioration of infrapopliteal run-off in the year after femoropopliteal PTA is accompanied by worsening of long-term femoropopliteal patency.
Authors:
V Salapura; A Blinc; M Kozak; M K Jezovnik; M Pohar Perme; P Berden; D Kuhelj; T Kljucevsek; P Popovic; M Stankovic; M Vrtovec; M Surlan
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  VASA. Zeitschrift für Gefässkrankheiten     Volume:  39     ISSN:  0301-1526     ISO Abbreviation:  VASA     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-13     Completed Date:  2010-06-17     Revised Date:  2012-10-19    
Medline Journal Info:
Nlm Unique ID:  0317051     Medline TA:  Vasa     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  159-68     Citation Subset:  IM    
Affiliation:
Clinical Institute of Radiology, University of Ljubljana Medical Centre, Ljubljana, Slovenia.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Amputation
Angiography, Digital Subtraction
Angioplasty, Balloon* / adverse effects
Arterial Occlusive Diseases / diagnosis,  mortality,  physiopathology,  therapy*
Chi-Square Distribution
Constriction, Pathologic
Female
Femoral Artery / physiopathology*,  radiography,  ultrasonography
Follow-Up Studies
Humans
Male
Middle Aged
Popliteal Artery / physiopathology*,  radiography,  ultrasonography
Prospective Studies
Recurrence
Regional Blood Flow
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Ultrasonography, Doppler
Vascular Patency*

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