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Objective:To explore the clinical efficacy of excimer laser atherectomy (ELA) in the treatment of diabetic foot with infrapopliteal arteriopathy.Methods:The clinical data of 36 patients (40 limbs) with diabetic foot complicated with inferior knee artery disease treated by ELA in Xinjiang Uygur Autonomous Region People′s Hospital from December 2019 to May 2021 were analyzed retrospectively. The success rate of ELA in the treatment of diabetic inferior genicular artery disease, ankle-brachial index (ABI), limb salvage rate and Visual Analogue Scale (VAS) score at 3 days and 3 and 6 months after operation was observed.Results:All the 36 patients were operated successfully, including 2 cases of flow-limiting dissection, 2 cases of arterial embolism and 1 case of hematoma at the puncture point. The ABI of patients 3, 6 months after operation was significantly higher than that before operation (all P<0.05), and the VAS score 3, 6 months after operation was significantly lower than that before operation (all P<0.05). The rate of limb (toe) salvage were 92.5%(37/40), 82.5%(33/40) at 3 d, 3 months and 77.5%(31/40) at 6 months after operation. Conclusions:ELA is safe and effective in the treatment of diabetic foot infrapopliteal arteriopathy, and the recent efficacy is fair.
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The infrapopliteal arteriosclerosis occlusive disease mainly involves the anterior tibial artery,posterior tibial artery and fibular artery.For the arteriosclerosis occlusive disease of larger arteries of lower extremity,such as iliac artery,femoral artery,etc.,the interventional therapy pattern has been already very mature.However,as the infrapopliteal artery is fine in diameter and the lesion is usually wide with extensive calcification,it is hard to effectively treat the infrapopliteal arteriosclerosis occlusive disease with routine interventional therapy.The therapeutic methods of infrapopliteal arteriosclerosis occlusive disease mainly include surgical treatment,endovascular treatment,drug therapy,and the autologous stem cell transplantation therapy that is still in the research stage at present.This paper aims to introduce the latest progress in interventional therapy for the treatment of infrapopliteal arteriosclerosis occlusive disease in recent years,and to make a prospect for clinical practice in future.
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Objective To report the preliminary results of drug eluting stents (DES) in infrapopliteal bifurcation lesions after failed angioplasty.Methods From April 2011 to December 2013, 21 patients with critical limb ischemia and infrapopliteal atherosclerotic disease underwent DES placement in tibial bifurcation using 4 techniques: balloon and stent (single stent), T-shape double-stent, Crush double-stent and Culotte double-stent.Clinical and angiographic end points included: Amputation-free survival, target lesion revascularization (TLR)-free survival, target vessel revascularization (TVR)-free survival.Angiographic primary and secondary patency of DES, 2-vessel primary patency (2VPP), and 1-vessel primary patency (1VPP).Results Technical success was achieved in all patients (100％) without major intraoperative complications.ABI increased from 0.23 ± 0.07 to 0.67 ± 0.24 (P ＜ 0.05) after 1 week.The mean follow-up intervals were 23 ± 7 months;amputation-free survival, TLR-free survival and TVR-free survival were 100％, 90.5％ and 79.1％, respectively, at 1 year.8 patients underwent angiography reevaluation.The angiographic primary and secondary patency of DES were 62.5％, 87.5％, respectively.The primary patency of 2VVP and 1VVP were 28.6％, 57.1％, respectively at 1 year.Conclusions Bifurcation stenting techniques utilized in coronary arteries can be used in the infrapopliteal arteries.Although provisional stenting in the origin of tibial bifurcation cannot inhibit restenosis in distal lesions treated with balloon angioplasty, clinical outcomes and limb salvage rates are acceptable for these techniques.
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Objective To investigate the clinical efficacy and value of percutaneous transluminal angioplasty (PTA) in treating arteriosclerosis obliterans (ASO) of lower extremity that shows no visualization of its vascular outflow tract. Methods A total of 19 patients with ASO of lower extremities showing no outflow tract visualization were included in this study. The patients included 11 males and 8 females with a median age of 66 years (48-79 years. The main clinical symptom was rest pain of the leg in all patients; 10 cases had different degrees of foot ulcer and gangrene. Preoperative multi-slice CT angiography and DSA examination were performed in all patents. After PTA, the patients were followed up for 12 months, the changes of the clinical symptoms and signs were recorded. The claudication distance, toe skin temperature, ankle-brachial index (ABI), toe-brachial index (TBI), and CT angiography or color Doppler examination were separately performed before and one, 3, 6 and 12 months after PTA. Results In the 19 patients (38 diseased limbs in total), ASO with no visualization of vascular outflow tract was detected in 54 arteries, 3%), posterior tibial artery (n=18, 33.3%), peroneal artery (n=9, 16.7%) and popliteal artery (n=2, 3.7%). The technical success rate of limb PTA was 89.5%, while the technical success rate of single artery PTA was 85.2%. After PTA, the skin temperature of all the diseased limbs that had been successfully treated was obviously improved, the pain was significantly relieved or disappeared. One, 3, 6 and 12 months after PTA, the claudication distance, toe skin temperature, ABI and TBI were strikingly improved when compared with those determined before PTA (P<0.05). Twelve months after PTA the vascular restenosis rate was 39.5% (15/38), the limb vascular patency rate was 55.3% (21/38), and the limb salvage rate was 81.6%(31/38). Conclusion For the treatment of lower extremities arterial obliterans with obstructed outflow tract, PTA is safe and effective in short-term period. Although its long-term restenosis rate is higher, this technique can effectively control the progress of the disease, relieve the clinical symptoms, and help improve the limb salvage rate of ischemic limbs.
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Objective Diabetic infrapopliteal artery occlusive disease Deep balloon angioplasty ( percutaneoustransluminal an-gioplasty, PTA) near the middle of the treatment effect and the Department of internal medicine ,conservative treatment .Methods Sixty patients with type II diabetes mellitus complicated with severe infrapopliteal arterial occlusive patients , divided into treatment group (41 cases) and Department of internal medicine treatment group (19 cases),all patients had CTA or MRA or DSA imaging;in-terventional treatment group using Deep balloonPTA ,3 days before operation and postoperative long-term Plavix and culture as anti platelet , blood glucose controltherapy;Department of internal medicine treatment group with control of blood glucose ,precedent in im-proving microcirculation ,debridement dressing and anti infection;observed in 2 week,1 month,3 months,6 months ,1 year,2 years,3 years, two groups were compared after treatment of clinical symptoms and changes signs ,ankle brachial index (ABI),the dorsal artery of foot diameter and blood flow velocity ,evaluation and the total efficiency of 6 months,1 year,2 years,3 years and cut rate .Results Interventional arterial blood flow improved significantly after operation in treatment group ,the clinical symptoms,signs were improved obviously, ankle brachial index improved significantly ,compared with the Department of internal medicine treatment group statistical significance ( P <0.05 ) ,and the total efficiency of 3 years the rate of limb salvage and Department of internal medicine therapy group with significant difference ( P <0.05).Conclusions Deep balloon PTA treating diabetic infrapopliteal artery occlusive disease cura-tive effect,can significantly improve the rate of limb salvage;Department of internal medicine treatment forelderly ,important organ dys-function patients .
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Objective To evaluate the results of endovascular intervention for infrapopliteal arterial occlusion in 40 patients. Methods There were 41 affected limbs in these 40 patients receiving 44 times of endovascular intervention for infrapopliteal arterial occlusion during Nov. 2006 and Dec. 2007. The average age was 76±6. The ABI(ankle brachial index)before intervention was 0.39±0.20 in anterior tibial artery and 0.39±0.23 in posterior tibial artery. CLI (critical limb ischemia) was 80.49% (33/41). Results The after intervention ABI increased by 0.43±0.22 (P<0.01) in anterior tibial artery and 0.43±0.25(P<0.01)in posterior tibial artery. 35 patients (36 limbs) were followed-up for (6±3) months. The limbs of Fontaine Ⅰ and Fontaine Ⅱ A were 28 (77.78%), CLI decreased to 19.44% (7/36) (P<0.01). At follow-up the ABI in anterior tibial artery was 0.63±0.22 and 0.56±0.22 in posterior tibial artery. The difference were all significant when compared with that before intervention and after intervention. The perioperative amputation rate was 0. The perioperative mortality rate was 2.5%. The total mortality rate was 15%. The limb salvage rate were 100%. Conclusion The effect of endovascular intervention for infrapopliteal arterial occlusion is satisfactory.
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Objective To evaluate the efficacy of endovascular interventional treatment for infrapopliteal arterial ischemic diseases. Methods Sixty patients(65 limbs)of infrapopliteal arterial isehernia of the lower extremities received pereutancotm transluminal angioplasty(PTA)and/or stents implantation from November 2004 to July 2007.The symptoms,changes of ankle/brachial index(ABI),limb salvage rate and immediate patent rate were observed. Results PTA/stenting procedure was successful in 51 out of 60 patients(65 limbs)with the technical success rate of 83.3%.Symptoms were improved in 53 cases(88.3%)including complete symptom remission in 40 cases(66.7%),partial remission in 13 patients(21.7%).The procedure failed in 7 cases(11.6%).In successful cases,AB1 increased from preoperative 0.40±0.18 to postoperative 0.91±0.22(P＜0.01).The amputation below knee was performed in two cases and toe apodizers in four cases.The limb salvage rate was 91% during the same hospitalization.Discharged 54 cases were followed up with 14.5±1.2 months,during this period amputation above knee was performed in 2 cases,amputation below knee in 2 cases,and toe apodizers in 2 cases,with a limb salvage rate of 88.9%(48/54).Symptoms were recurrent in five cases,with recurrence rate of 9.2%.Vascular reocclusion or restenosis were found in 10 cases.the patent rate was 81.5% and the cumulative patent rate was 57.3% in one year. Conclusions Endovascular interventional treatment for infrapopliteal arterial ischemic disease is safe and effective.
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PURPOSE: Femoro-infrapopliteal bypass is usually indicated for the patients with critical leg ischemia and when below- knee femoro-popliteal bypass is not available. Considering the technical difficulties and requirement of longer vein graft, inferior surgical outcomes are anticipated after femoro-infrapopliteal bypass compared to below-knee femoro-popliteal bypass. We attempted to compare the early and late outcomes between the patients who underwent below-knee femoro-popliteal and femoro-infrapopliteal bypasses. METHODS: Among 285 autologous reversed vein grafts implanted for the patients with chronic atherosclerotic leg arterial occlusion, the data base of 119 below-knee femoro-popliteal and 97 femoro-infrapopliteal bypasses (4 tibioperoneal trunk, 52 posterior tibial, 10 anterior tibial, 20 peroneal, and 11 inframalleolar arteries) were retrospectively reviewed to compare the patients characterisitics and surgical outcomes. To compare early postoperative outcome, operative mortality (<30 days), ankle-brachial pressure index, early graft failure, wound complication, and major limb amputation were compared and to compare late outcome, primary cumulative patency rates of vein grafts were compared between 2 groups. Cumulative patency rates were determined by Kaplan-Meier method and compared with log-rank test between 2 groups. RESULTS: Demographic features and frequencies of comorbidities including diabetes, coronary artery disease, chronic obstructive lung disease and cerebrovascular disease were not different between 2 groups except renal insufficiency which is more frequent in femoro-infrapopliteal bypass group. And femoro-infrapopliteal bypasses were more commonly indicated for the patients with ischemic tissue loss and as repeated bypass and requiring spliced vein graft more commonly. There revealed no significant differences in the frequencies of operative mortality (<30 days), early graft failure, wound complication, and major limb amputation and the amount of ABI increase between 2 groups. Primary cumulative patency rates at 1, 3, and 5 years were 88.1 +/-3.5%, 77.3+/-5.1%, and 64.5+/-7.4% after B-K femoro- popliteal bypasses and 87.9+/-4.1%, 72.5+/-6.3%, and 60.4+/-10.1% after femoro-infrapopliteal bypasses, respectively revealing no significant differences between 2 groups. CONCLUSION: In spite of anatomical and technical disadvantages associated with femoro-infrapopliteal bypasses, there revealed no significant difference in early and late outcomes between below-knee femoro-popliteal and femoro- infrapopliteal bypasses with autologous reversed vein graft.