Long Term Effects of Below-the-Knee Angioplasty in Diabetic Patients with Critical Ischemia of Lower Limbs Referred to Sina Hospital During 2010-2011

Abstract

Despite significant advances in the treatment of diabetic foot ulcers and below-the-knee critical ischemia, there are ongoing efforts to achieve a method with low complication, high success rate and persistence of long-term effects.was to examine the outcome of angioplasty in patients with below-the-knee critical ischemia referred to Hospital.. This semi-experimental study conducted on diabetics patients treated with PTA (Percutaneous transluminal angioplasty) with critical ischemia of lower limbs referred to Sina Hospital. After discharge, the patients were followed weekly for the first month and then monthly up to 12 months. The procedure short-term effects were examined through evaluation of wound healing as well as patients' recovery and pain relief, after one month. Given the distribution type, parametric and non-parametric test were used to compare the results before and after treatment. Pearson's correlation coefficient was used to determine the correlation between variables.. Twenty four patients participated in this study. The mean ankle-brachial index (ABI) at baseline was 0.55±0.17. A month after angioplasty, the index increased statistically significant to 0.93±0.16. The mean health score expressed by the patients at baseline was 5.48±1.39. A month after angioplasty, it was significantly increased (6.32±1.24). The mean pain score before enrollment was 6.68±2.52 (according to VAS scale). There was a significant decrease over time (3.45±1.13). The overall mean score of all patients at Rutherford Classification was 3.88±0.63 at baseline. During the 1st month and 6th month follow-up, it was changed to Class 0 that was statistically significant in the first month.. This study represents the mid-term outcomes of PTA. Although PTA treatment was associated with improved pain scores, satisfaction with health, classification of limb ischemia and diabetic foot ulcers, the effects only remain short-term and mid-term. However, long-term efficacy of PTA needs to be investigated further.

Comparative Study Between Infragenicular Balloon Angioplasty and Conservative Management in Treatment of Patients With Critical Lower Limb Ischemia

“…This was not comparable with Zafarghandi et al, 2015, who found in a study conducted to examine the outcome of angioplasty in patients with below-the-knee critical ischemia that peroneal artery was present in (50%) of patients, (ATA) in (26.92%) of patients, while the (PTA) in (84.61%) patients . [18] Moving to technical success in our study, we find that 92% (36 patients) technically succeeded regarding crossing the lesion, dilatation with residual stenosis less than 30% while failure restricted in two cases due to failure to pass the lesion because of heavy calcification which can be correlated to Conrad et al, 2009, who conducted a study on Infrapopliteal balloon angioplasty for the treatment of chronic occlusive disease, they recorded technical success up to 71.6%. Similarly, Vraux et al, 2000 who evaluated the feasibility and preliminary results at 1 year of angioplasty of tibial occlusions in critical limb ischaemia (CLI) reported a technical success rate of 78% in 40 patients undergoing infrapopliteal PTA for CLI.…”

“…Similarly, Vraux et al, 2000 who evaluated the feasibility and preliminary results at 1 year of angioplasty of tibial occlusions in critical limb ischaemia (CLI) reported a technical success rate of 78% in 40 patients undergoing infrapopliteal PTA for CLI. , [18] Technical success was lower in patients with TASC D lesions at 50%, compared with 63% as reported previously by Kok et al, 2017 and technical success for the remaining A-C lesions was as higher at 100% as Kok et al, 2017, 81%. [13] After excluding mortality, the overall clinical success, wound healing and limb salvagability in our study was 76.3% while in Conrad et al, 2009 it was 86.2 %.…”

“…( Marston et al, 2006) found that multivariate risk factor analyses revealed that ABI was independently associated with amputation at 1 year. At 12 months, 32% of limbs with an ABI _0.5 and 43% of limbs with an ABI _0.4 required amputation compared with 15% of limbs with an ABI between 0.5 and 0.7 (P _ .01) [18] Looking at the amputation as a failure representative, we found that 16 patients underwent major amputation (41.8%) and in Brass et al, 2006 study was (16.2%) while in the endovascular group, it was (23%). [17] Regarding mortality in conservative group, 10 patients (26.3%) expired due to extensive co morbidities associated as MI and stroke and in Brass et al, 2006 it was (10%) while in endovascular group it was (21%) [17] CONCLUSION From our study we conclude that endovascular intervention is better than conservative management regarding limb salvagability, wound healing and life quality.…”