Predictors for Better Blood-Flow Restoration of Long-Segmental Below-the-Knee Chronic Total Occlusions after Endovascular Therapy in Diabetic Patients

OBJECTIVE: To prospectively investigate predictors for good restoration of blood flow of below-the-knee (BTK) chronic total occlusions (CTOs) after endovascular therapy in diabetes mellitus (DM) patients. MATERIALS AND METHODS: A total of 120 long-segmental (≥ 5 cm) BTK, CTOs in 81 patients who underwent recanalization were included in this study. After angioplasty, blood-flow restoration was assessed using modified thrombolysis in myocardial ischemia grades and classified as good flow (grade 3) and poor flow (grade 1/2). One hundred and six CTOs with successful recanalization were divided into a good flow group (GFG; n = 68) and poor flow group (PFG; n = 38). Multivariate logistic regression analyses were undertaken to determine independent predictors of blood-flow restoration. Receiver operating characteristic curves were constructed to determine the best cutoff value. The prevalence of target-lesion restenosis during follow-up was compared between two groups. RESULTS: Univariate analyses suggested that CTOs in GFG were characterized by lighter limb ischemia (p = 0.03), shorter course of ischemic symptoms (p < 0.01) and lesion length (p = 0.04), more frequent use of intraluminal angioplasty (p = 0.03), and higher runoff score (p < 0.01) than those in PFG. Multivariate regression analyses suggested that distal runoffs (p = 0.001; odds ratio [OR], 10.32; 95% confidence interval [CI]: 4.082–26.071) and lesion length (p < 0.001; OR, 1.26; 95% CI: 1.091–1.449) were independent predictors for good flow restoration. Kaplan-Meier analyses at 12 months showed a higher prevalence of non-restenosis in GFG (p < 0.01). CONCLUSION: Distal runoffs and lesion length are independent predictors for good flow restoration for long-segmental BTK, CTOs in DM patients who receive endovascular therapy.

An Effective Guidewire Looping Technique for the Recanalization of Occlusive Segments of Infrapopliteal Vessels

OBJECTIVE: To determine the efficacy, safety and primary follow-up results of a guidewire looping technique for the treatment of infrapopliteal arteries. MATERIALS AND METHODS: From October 2006 to May 2008, an intraluminal angioplasty of the infrapopliteal arteries was attempted in 200 consecutive patients. Altogether, 417 infrapopliteal lesions, with lengths varying from 2 cm to 32 cm, were treated as part of this study, including 305 lesions in the anterior tibial arteries, 89 in the posterior tibial arteries, and 23 in the peroneal arteries. The 'U'-shaped guidewire technique was attempted in 393 lesions from 361 limbs. The tip of a hydrophilic 0.035-inch guidewire was formed into a 'U' shape with the aid of a 4-Fr catheter and collateral branch vessel to recanalize the completely occluded long segment lesions. RESULTS: A successful angioplasty with at least one artery recanalized directly to the malleolar or dorsal foot was achieved in 322 limbs (89%). The looping technique had a success rate of 90% (352 of 393 lesions). After the procedure, the rest pain was relieved in 58 of 69 patients, while 207 of 245 limbs (85%) showed improvement for intermittent claudication. Complete wound healing was noted in 21 of 54 patients, while 20 of 54 patients showed an improvement in the wound size or depth. A total of 38 major immediate procedure-related complications were noted, including retroperitoneal hematoma, distal emboli, and vessel rupture. CONCLUSION: The results of this study suggests that the guidewire looping technique is a safe and effective method for the recanalization of the occluded lesions in infrapopliteal vessels.

Clinical evaluation of treatment for diabetic foot with PTA and PTA combined cinepazide maleate / 介入放射学杂志

Objective To investigate the clinical value for treatment of diabetic foot with PTA and PTA combined cinepazide maleate.Methods In 24 cases of diabetic associated vascular disease of lower limb,12 cases were treated with PTA and other 12 cases were treated with PTA combined einepazide maleate,We analysed and compared clinical effects before and after the procedure,together with 3 months follow up.Results In patients treated with PTA,the clinical symptom scores of posttreatment and follow-up decreased;ABI and TcPO_2 increased significantly.The clinical symptom score and ABI of follow-up remained,stable,but TcPO_2 decreased significantly.Control angiography showed improvement in degree of vascular stenosis and peripheral staining of 11 patients after treatment.The vascular patency remained in 12 patients and the peripheral staining decreased in 7 patients on follow-up.In patients treated with VIA combined cinepazide maleate,the clinical symptom score,ABI and TcPO_2 after treatment and on follow-up showed no signifcant changes compared with those in patients treated by PTA.F,Control angiography showed that the degree of vascular stenosis and peripheral staining were improved in 12 patients after treatment.The vascular pateney was maintained and peripheral staining was improved on follow-up.Before and after treatment,there were no significant differences in clinical symptom score.ABI and TcPO_2 between patients treated with PTA and PTA combined cinepazide maleate,however,there were significant differences in clinical symptom score and TcPO_2 on follow-up.Conclusion PTA can significantly improve clinical symptom of diabetic foot and the application of cinepazide maleate is a benefitial and necessary supplement.PTA combined cinepazide maleate can be taken as one of the conventional treatment plans for diabetic foot.(J Intervent Radiol,2007,16:811-815)