Clinical outcome and restenosis following percutaneous transluminal angioplasty for ischaemic rest pain or ulceration

Abstract

The role of percutaneous transluminal angioplasty in the management of severe leg ischaemia is controversial. To investigate further the efficacy of angioplasty and the clinical consequences of restenosis, a randomly selected cohort of 29 patients with ischaemic rest pain or ulceration was studied for 6 months after a technically successful balloon angioplasty. All patients had digital subtraction arteriography at the end of follow-up. Seven of 15 patients undergoing the procedure for rest pain had sustained relief from the initial dilatation. Partial or complete healing was noted in all 14 patients with ulceration and was maintained at 6 months in 11 despite significant (greater than 30 per cent) restenosis at the angioplasty site in eight. There were no complications or clinical deterioration associated with the procedure. Angioplasty is an effective method for treating the severely ischaemic leg, especially when used to achieve ulcer healing; restenosis is often clinically unimportant.

Balloon Angioplasty in Chronic Critical Limb Ischemia: Factors Affecting Clinical and Angiographic Outcome

“…The 61% 1-year restenosis rate was fairly representative of the CLI population, 14,15 even if the subgroup with follow-up angiography had not been a random sample. In fact, fewer arterial segments treated per limb in patients with follow-up angiography suggest an even higher restenosis rate for the entire series.…”

“…Hence, compared to patients with intermittent claudication, patients with CLI seem to have much higher restenosis rates. [30][31][32][33] Tschopl et al 15 reported a 71% 6-month restenosis rate in 17 patients, while Ray et al 14 found restenoses in more than half (55%) of their 29 patients.…”

“…[1][2][3][4][5][6][7] In various historical series, BA was compared with bypass surgery, [8][9][10] and even selective infrapopliteal angioplasty was shown to be clinically effective. [11][12][13] However, there are only 2 prospective analyses with angiographic follow-up, 14,15 and little is known about risk factors influencing outcome in patients with end-stage occlusive peripheral arterial disease (PAD).…”

Subintimal angioplasty for superficial femoral artery occlusion: poor patency in critical ischaemia

“…The choice of the most appropriate procedure will depend on many factors including risk factors, co-morbidity, mobility, quality of life and anatomy of the disease. Patency using traditional PTA appears inferior to bypass surgery [10][11][12] although there are no randomised trials to support this. 13,14 The subintimal technique proposed is yet to be proven as a successful alternative to surgical bypass and appears to have poor patency in the short term.…”

Role of Hybrid Procedures in Treatment of Critical Lower Limb Ischemia

“…However, the primary use of lower limb endovascular treatment has not been very effective. 9,10 The CFA is the main inflow vessel for the entire lower limb and a major arterial access site. For small studies with variable success, endovascular treatment of symptomatic CFA stenosis has been attempted and is not used regularly.…”