Percutaneous transluminal angioplasty in severe diabetic foot ischemia: outcomes and prognostic factors

To evaluate the outcomes of severe ischemic diabetic foot ulcers for which percutaneous transluminal angioplasty [PTA] was considered as the first-line vascular procedure. Factors associated with successful PTA were sought. In 32 consecutive diabetic patients with foot ulcers and severe limb ischemia, PTA was performed if feasible; if not, primary bypass grafting was done when feasible. All patients were followed until healing or for at least one year. Patients with worsening ulcers after PTA underwent bypass grafting. Clinical and angiographic factors influencing outcomes after PTA were sought by univariate and multivariate analysis. PTA was done in 25 of the 32[78%] patients, and considered clinically successful in 13 [52%]. After 1 year, the healing rate was 70% and the limb salvage rate 90%. Successful PTA was significantly associated with a higher post-PTA transcutaneous oxygen pressure [P = 0.03] and presence of at least one patent pedal vessel [P = 0.03] in the univariate analysis; only a patent pedal vessel was significant in the multivariate analysis. In conclusion primary PTA in diabetic patients with severe ischemia foot ulcers provides similar outcomes to usual results obtained in severe ischemia in absence of diabetes. The presence of one patent pedal vessel on arteriography before PTA is the best prognostic factor

Pseudoaneurysm of a saphenous bypass treated covered endograft in the ascending aorta: the first clinical experience

As has been suggested for abdominal and thoracic aortic aneurysm, endografts could decrease morbidity and mortality in high-risk surgical patients. We report a case of a saphenous bypass pseudoaneurysm in a high risk patient. An endovaseular procedure using an ascending aortic endograft seemed to be a reasonable option to exclude the pseudoaneurysm. No suitable endograft was commercially available in the market. We therefore preferred to use a specially tailored homemade endograft.This is the first clinical report of a saphenous vein grafit dilatation treated with an ascending aortic endograft