Long-term Outcomes after Angioplasty of Isolated, Below-the-knee Arteries in Diabetic Patients with Critical Limb Ischaemia

Abstract

Surg 2009;xx:xx-xx.Background: It has been shown that concomitant percutaneous transluminal angioplasty (PTA) of above-the-knee (ATK) and below-the-knee (BTK) arteries is highly beneficial for limb salvage in patients with critical limb ischaemia (CLI), but few published studies have specifically investigated outcomes in diabetic patients with CLI associated with isolated small BTK-vessel disease. This study aimed to evaluate the long-term results of successful PTA for limb salvage in such patients.Materials and methods: From among the 634 patients with CLI in our database, we retrospectively selected a consecutive series of 101 diabetics (16%) with 107 critically ischaemic limbs (33 Rutherford 5 and 74 Rutherford 6) and no critical ATK lesion, who underwent PTA on isolated BTK lesions.Results: The limb salvage rate was 93% after a mean follow-up of 1048 Ϯ 525 days (2.9 Ϯ 1.4 years). Transcutaneous oxygen tension significantly increased after 1 month (18.1 Ϯ 11.2 vs. 39.6 Ϯ 15.1; p Ͻ 0.05). After 1 year, target-vessel re-stenosis had occurred in 42% of the non-amputated limbs, nine patients (9%) had died because of medical conditions unrelated to PTA and three patients had undergone repeat PTA for recurrent CLI.Conclusions: In our selected patient population with ischaemic diabetic foot and isolated BTK lesions, a successful endovascular procedure led to a high percentage of limb salvage at long-term follow-up. Readers can access EJVES articles at

Endovascular Treatment of Diabetic Foot in a Selected Population of Patients with Below-the-Knee Disease: Is the Angiosome Model Effective?

“…Our results are in line with those of Ferraresi et al [30]. At a mean follow-up of 17.5 ± 12 months, we observed a limb salvage rate of 87 %, a major amputation rate of 9.4 %, and a mortality rate of 3.5 %.…”

“…In our experience, endovascular treatment of the BTK area therefore gives satisfactory results, and in agreement with studies reported in the literature [30], we believe that the PTA of these vessels decisively contributes to the treatment of CLI in diabetic patients.…”

“…In the literature, we found only one similar study, by Ferraresi et al [30], with 101 BTK-alone diabetic patients with CLI treated with PTA that demonstrates, at a mean follow-up of 2.9 ± 1.4 years, a limb salvage rate of 93 %, a major amputation rate of 7 %, and a minor amputation rate of 64 %.…”

“…The main studies in the literature [13,16,[23][24][25][26][27][28][29][30] reported, for endovascular treatment, a technical success rate of about 90 %, a negligible mortality rate, and a limb salvage rate at 3-5 years of 72-98 %.…”

“…In a meta-analysis comparing the results of the surgical and endovascular approach of BTK area, Romiti et al [32] reported a rate of limb salvage at 3 years that was comparable for the two techniques (PTA 82.4 ± 3.4, surgery 82.3 ± 3.0). Several other studies [23][24][25][26][27][28][29][30] evaluated the effectiveness of PTA in diabetic foot patients, but these studies are limited by their main conditions, including a heterogeneous population with BTK and/or ATK disease. Moreover, the effectiveness of BTK-area PTA is still a matter of debate; the small size of the treated vessels appears to be associated with an increased rate of restenosis, and in patients with chronic ATK and BTK knee disease, it is unclear whether the clinical success is linked to the PTA of either the ATK or BTK area alone [33].…”