Is Inframallolar Angioplasty Effective for Wound Healing in Patients with Critical Lower Limb Ischemia and Tibial Only Disease?

Abstract

Background Prevalence of PAD is approximately 3–10% in the population as a whole, with this increasing to between 15 and 20% when focusing on older patients (> 70 years of age). Critical limb ischemia is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Aim of the Work The aim of the study is to assess the outcome of inframallelar angioplasty in patients with multiple tibial and pedal arch disease by the impact of technical success in the form of Angiogrophically improvement of pedal arch classification and clinical success by wound healing. Patient and Methods In this observational prospective study; 40 patients were selected from the Ain Shams University Hospitals either at OPC or ER. Patients were subjected to Duplex study and Computerized tomography (CT) angiography for investigation. Patients were treated by balloon angioplasty. Post-intervention medical treatment included: Anti-platelet, Acetylecysitene & fluids. Results Incomparison between the Complete Pedal Arch(CPA), Icomplete Pedal Arch(IPA), Absent Pedal Arch (APA) show no significant change demography and different comorbidities as regard age, gender, smoking, and other co-morbitidies as diabetes, hypertention, renal insufficiency, and obesity. Comparison between 3 groups in terms of wound healing show significant differnerence between CPA(91.7%), IPA (88.9%) and APA (50%) while non significant difference between CPA and IPA. In terms of healing duration it shows non significant difference between CPA and IPA, significant difference between IPA and APA and high significance diference between CPA and APA. Conclusion This is a prospective observational cohort study to asses the outcome of inframallelar angioplasty in patients with multiple tibial and pedal arch disease by the impact of technical success in the form of Angiogrophically improvement of pedal arch classification and clinical success by wound healing. Our study proved that inframalleolar angioplasty play effective role in improving the foot wound healing, shortening its duration in the chronic threatening limb ischemia patients, improving limb salvage and quality of life.