Abstract
Clinical and statistical study analysing factors with influence on success rates, procedure-related complications, and long-term results for patients who underwent angioplasty of the crural arteries. Retrospectively we evaluated all patients who underwent angioplasty of the crural arteries due to critical chronic limb ischemia or severe claudication in the time period from 1/2002 to 12/2005. These patients were contacted in the time period from 1/2009 to 12/2010, and a follow-up examination including angiography was performed or telephone interviews were conducted with patients, relatives and referring physicians for follow-up. 212patients with a mean age of 77.8years (99women and 113men) underwent crural angioplasty on 239limbs. The primary end points were the limb salvage rate and patient survival rate. The secondary end points included the complication rate, technical success rate, and patency rate. The prognostic relevance of treatment and selected variables with respect to limb salvage and patient survival were analysed with multiple logistic regression. The technical success rate was 98.4%. Between 1/2009 and 12/2010, 49.5% of the patients died. An angiographic follow-up study was performed in 49.9% of the treated legs. The primary patency-rate (72% after 6months and 62.8% after 12months) was significant, influenced only by the riskfactor dialysis (p= 0.0207). After a mean follow-up of 3.7years, 48patients (22.6%) experienced minor- or major-amputation on 53legs (22.2%). The limb salvage rate (Kaplan-Maier estimation) was 85.4% after 5years. The mean survival rate according to Kaplan-Meier was 79.7, 72.2, 67.3 and 51.4% after 1, 2, 3 and 5years, respectively. Results of multiple logistic regression analysis showed that negative prognostic variables with respect to patient survival were amputation (p= 0.0017) and dialysis (p= 0.0011) and with respect to limb salvage dialysis (p< 0.0001) and non-patent peroneal artery (p< 0.0001). Balloon angioplasty of the crural arteries shows a high technical success rate with an acceptable complication rate. Dialysis and non-patent peroneal artery are negative prognostic variables for the clinical long-term success.
Highlights
We evaluated all patients who underwent angioplasty of the crural arteries due to critical chronic limb ischemia or severe claudication in the time period from 1/2002 to 12/2005. These patients were contacted in the time period from 1/2009 to 12/2010, and a followup examination including angiography was performed or telephone interviews were conducted with patients, relatives and referring physicians for follow-up. 212 patients with a mean age of 77.8 years (99 women and 113 men) underwent crural angioplasty on 239 limbs
The prognostic relevance of treatment and selected variables with respect to limb salvage and patient survival were analysed with multiple logistic regression
Results of multiple logistic regression analysis showed that negative prognostic variables with respect to patient survival were amputation (p = 0.0017) and dialysis (p = 0.0011) and with respect to limb salvage dialysis (p < 0.0001) and nonpatent peroneal artery (p < 0.0001)
Summary
Die Prävalenz der peripheren arteriellen Verschlusskrankheit (PAVK) wird mit 3–10 % angegeben, wobei sie mit steigendem Alter deutlich zunimmt und bei Patienten über 70 Jahre bei etwa 15–20 % liegt [1, 2]. Bei über zwei Drittel der Personen mit Claudicatio intermittens bleiben die Beschwerden stabil, und das Risiko, dass in den nächsten 5 Jahren ein chirurgischer Eingriff oder eine Amputation nötig ist, liegt lediglich bei etwa. Allgemein liegt die Hauptbedrohung der PAVK indessen nicht in den lokalen Komplikationen, sondern – da sie in vielen Fällen von einer obstruierenden Arteriosklerose der koronaren und intrakraniellen Gefäße begleitet ist – in der deutlich erhöhten Gefahr, einen Herzinfarkt oder Schlaganfall zu erleiden. TASC II (Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease), einigte man sich auf eine Klassifizierung und Therapieempfehlung in Abhängigkeit von Lokalisation und Ausprägung der Läsion [4]. Wir benutzten deshalb die „Guidelines for Percutaneous Transluminal Angioplasty“ des „Standards of Practice Committee of the Society of Cardiovascular and Interventional Radiology“, da hier klare Vorgaben zur Behand-
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call