INFRAPOPLITEAL BALLOON ANGIOPLASTY FOR CRITICAL LIMB ISCHEMIA | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 33, Issue 1, January 2014, Page 32-38 PDF (525.91 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2014.366638 | ||||
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| Authors | ||||
| Hesham Abd Alla* 1; Hosam Roshdy1; Khaled El Alfy1; H. K. Hussein2 | ||||
| 1General & Vascular Surgery Department, Faculty of Medicine, Mansoura University, Egypt | ||||
| 2Vascular Surgery Department, Cairo University, Egypt | ||||
| Abstract | ||||
| Background: Lower extremity peripheral arterial disease (PAD) is a major cause of morbidity and mortality. Percutaneous endovascular therapy is an alternative to surgery for the treatment of PAD. While infrapopoliteal PTA was restricted to patients with short stenotic lesions or poor candidates for bypass, recently it has been used preferentially over bypass surgery by some groups due to the advent of new devices and techniques. The growing experience with endovascular therapy justifies an assessment of crural PTA. The aim of this study is reviewing our results in infrapopliteal angioplasty stratifying patients by anatomic characteristics according to the TASC classification. Patients and Methods: This study was conducted at Arab Contractors Medical Center and Mansoura University Hospital on 80 patients during the period from Jan 2009 till April 2013. Inclusion criteria were rest pain, ulceration and tissue necrosis. Exclusion criteria were life threatening infection, Burger’s disease and multilevel lesions. All patients were investigated by colour duplex scan, C.T.Aor M.R.A. The TASC “I” classification for tibioperoneal occlusive disease was done. All procedures were done with local anesthesia, sometimes sedation was needed for irritable patients. Cases were performed preferentially through antigrade ipsilateral femoral access and rarely through retrograde contralateral access. All patients were anticoagulated with 10,000 IU heparin after initial angiography. We used 6F sheaths for ipsilateral antigrade access and 8F sheath for retrograde contralateral access, 4F vertebral catheters were used with 0.035 floppy angled giudewire (Terumo, Somerest, ND), 0.018, 0.014 hydrophilic wire (Boston Scientific, Natick, Mass) or glide wire. Five cases had direct tibial vessel puncture using fluoroscopic guidance had been done. Angioplasty was performed with low profile balloon (Amphirion Deep, Invatec, Italy) 2.5 to 3F. Balloon was inflated for 1 to 3 minutes. If vasospasm occurred; administration of 50-400 mcg of nitroglycerin was helpful. After the procedure, patients were given 600 mg loading dose of clopidogrel, if the patient didn’t receive it preoperatively, maintained on 75 mg daily dose for 3 months to one year, along with aspirin and statins. EJS, Vol. 33, No. 1, January 2014 33 Results: During the study period, 80 patients underwent PTA [14 (17.5%) for rest pain and 66 (82.5%) for tissue loss] after exclusion of five cases from the study due to failure of guide-wire passage. Antigrade access was used in 73 cases (91.25%) and seven cases (8.75%) retrograde access was performed due to difficult puncture. Primary patency was 58.75% at first year and 48.75% at second year. First year primary patency for TASC A through D was 83.3%, 87.5%, 45%, 34.6% respectively. And for Second year was TASC A through D was 72.2%, 68.75%, 40%, 26.9% respectively. Limb salvage at 1 year: 81%, and at 2 year: 75%. Conclusion: PTA is recommended as first line of treatment for TASC A, B, C lesions and TASC D patients who are not candidate for bypass. But more studies are needed to compare long term follow up between PTA and bypass in TASC D lesions. | ||||
| Keywords | ||||
| Peripheral arterial disease; percutaneous endovascular therapy; TASC; Angioplasty | ||||
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