1764347LONG SEGMENT INFRA-POPLITEAL ANGIOPLASTY IN PATIENTS WITH CRITICAL LIMB ISCHAEMIA. THE ROYAL LONDON HOSPITAL EXPERIENCE.

SHIRISH G. PRABHUDESAI1, DEBORAH LOW1, IAN RENFREW1, MATTHEW MATSON1, NICOS FOTIADIS2

DEPARTMENT OF INTERVENTIONAL RADIOLOGY, 1 THE ROYAL LONDON HOSPITAL, 2 THE ROYAL MARSDEN HOSPITAL

Aims

To evaluate the technical and clinical outcome of percutaneous transluminal infra-popliteal angioplasties (PTIA) +/- stenting in a subgroup of patients with critical limb ischaemia (CLI).

Materials and Methods

The study included patients with CLI who underwent long segment infra-popliteal angioplasty between 2007 and 2011. Primary outcomes evaluated were technical success, immediate / post procedural complications, restenosis, re-intervention, and amputation. Secondary outcomes evaluated were symptom relief and patient survival.

Results

35 patients (38 consecutive limbs) were treated with PTIA+/-stenting. Mean age was 74 years, 62.8% were men. Technical success was 86% with failure to traverse the lesion in 1 and incomplete re-canalisation in 4 patients. No major procedure related complications. Of the 30 patients and 33 limbs who had technical success, 2 had re-intervention at 6 and 10 months respectively with good

results. 4 patients were stented in addition to PTIA. 8 patients had major and 1 had minor (toe) amputation. Of the 30, 7 patients died within 1 year of the procedure and 2 following 1 year. At the end of 1 year of the surviving 23 patients and 26 consecutive limbs, 6 had major and 1 had minor amputation. Amputation-free survival was 74% at 1 year. Overall survival at 1 year was 77% with no procedure related mortality. 58% patients were symptom free at the time of last follow up.

DiscussionThe primary aim of infra-popliteal angioplasty is the recanalizationof one straight line of pulsatile flow to the foot in order to adequately reperfuse the distal ischemic tissue 1.

The technical success and limb salvage rate in patients with CLI

treated using infra-popliteal angioplasty approach 90 and 70%

respectively,2 compared to 86% and 74% in our study which included much longer lesions.

Conclusion

PTIA+/- stenting is an efficient treatment modality in patients

with severe CLI and tissue loss. In this high risk patient group,

endovascular treatment can improve symptoms and prevent

or delay the need for amputation.

References1. Tsetis D, Belli AM (2004) The role of infrapopliteal angioplasty. Br J Radiol 77(924):1007–1015.2. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg

2007; 45(suppl S):S5-67.

3a) 71 year old diabetic female, hypertensive, ex-smoker with left heel ulcer. Long occlusions of the AT and PT and severe stenosis of the proximal peroneal.

b) & c) The peroneal and proximal PT were recanalized with a 3mm x 10cm balloon. The ulcer healed completely after 8 weeks.

1 a) Long occlusion of the left PT.(red arrows) in a 68 year old diabetic, hypertensive male, with non healing ulcer, medial aspect of foot.

b) & c) Angioplasty of PT with 2.5mm x15cm balloon restoring continuous flow with the medial plantar arch.

d) Satisfactory recanalisation of the left PT which is now the dominant vessel to the foor. The ulcer healed .

2 a) & b) Long occlusion of the left PT (red arrows) in a 72year old male with diabetes mellitus, hypertension, end stage renal disease.and necrotic great toe and heel ulceration.

c) Successful restoration of flow following angioplasty of the left PT with 2.5mm x 15cm balloon.

1a 1b 1c 1d 2a 2b 2c 2d 3a 3b 3c