Percutaneous transluminal angioplasty for isolated infrapopliteal arterial occlusive disease in diabetic patients with critical limb ischemia

Abstract

Background Critical limb ischemia (CLI) is considered the most severe stage of peripheral artery disease. Patients with CLI typically have the disease affecting multiple levels (i.e. aortoiliac, femoropopliteal, and infrapopliteal). CLI due to isolated infrapopliteal arterial disease is commonly seen in patients with long-standing diabetes mellitus, chronic kidney disease, or the elderly. Endovascular treatment of infrapopliteal arteries has been considered a primary approach for revascularization in CLI. Objective The aim of this study was to evaluate the efficacy of percutaneous transluminal angioplasty (PTA) for isolated infrapopliteal arterial occlusive disease in diabetic patients with CLI. Patients and methods This prospective study included 20 diabetic patients with CLI in 28 limbs due to isolated infrapopliteal arterial occlusive disease who underwent infrapopliteal PTA between January 2017 and January 2019 in Mataria Teaching Hospital, Cairo, Egypt. Results The study was conducted on 20 diabetic patients, 12 (60%) men and eight (40%) women. Their age ranged between 54 and 76 years with a mean age of 65 years. Successful recanalization was achieved in 23 (82.1%) limbs. Reintervention was needed in five (17.9%) limbs and it was successful in four limbs. The follow-up period ranged from 6 to 18 months with the mean overall follow-up being 12.5 months. The primary patency rate and secondary patency rate were, respectively, 78.3 and 80% at 1 year. The limb salvage rates after 1 year were 75%. Mortality rate after 1 year was 10%. Conclusion PTA is effective and the preferred procedure for revascularization and limb salvage in diabetic patients with CLI due to isolated infrapopliteal arterial occlusive disease.