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Objective:To analyze the effect of endovascular therapy (including balloon dilation, debulking and anti-restenosis technique) for below-the-ankle atherosclerotic lesions in chronic limb threatening ischemic patients.Methods:A retrospective analysis was performed on the clinical data of 465 patients (570 limbs) with below-the-ankle atherosclerosis who were consecutively admitted to Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University from April 2018 to December 2021. All patients received balloon dilatation below the ankle artery as basic treatment, including 67 patients in debulking subgroup, 82 patients in anti-restenosis subgroup and 11 patients in the triple therapy subgroup. The reocclusion rate, target lesion reintervention rate at 1, 3, 6 and 12 months after surgery were compared; The wound healing rate at 3 months, limb salvage rate at 6 and 12 months and mortality at 12 months in the Global Limb Anatomic Staging System (GLASS) grading groups P0, P1 and P2 were compared.Results:The technical success rate of this group was 76.0%(433 limbs/570 limbs). The follow-up rates of 6 and 12 months after operation were 85.4%(370 limbs/433 limbs) and 75.3%(326 limbs/433 limbs), respectively. The length of treated lesions was (3.6±1.3)cm; The reocclusion rates were 5.5%(23 limbs/420 limbs), 8.2%(33 limbs/403 limbs), 14.9%(55 limbs/370 limbs) and 23.6%(77 limbs/326 limbs) at 1, 3, 6 and 12 months after operation; The reintervention rate of target lesions in 6, 12 months was 7.6%(28 limbs/370 limbs) and 12.0%(39 limbs/326 limbs) respectively; The wound healing rate in groups P0, P1 and P2 within 3 months was 87.3%(192 limbs), 70.5%(62 limbs) and 10.5%(2 limbs) respectively ( P<0.001), the limb salvage rate in 6 months was 96.2%(200 limbs), 84.7%(127 limbs) and 33.3%(4 limbs) respectively ( P<0.001), and the limb salvage rate in 12 months was 78.7%(170 limbs), 54.5%(55 limbs) and 22.2%(2 limbs) respectively ( P<0.001). The mortality was 6.9%(32/465) 12 months after operation. Conclusions:Endovascular therapy below-the-ankle is feasible and has high technical success rate. The constitute integrity of pedal-plantar loop in limb- threatening phase is related to 3-month wound healing rate and limb salvage rate.
RESUMO
Objective To assess the feasibility and efficiency of pedal-plantar loop technique in the treatment of below-the-ankle arterial occlusion . Methods A retrospective analysis was undertaken on 12 cases ( 14 legs ) of below-the-ankle arterial occlusion.The pedal-plantar loop angioplasty was performed in all the cases .Balloon angioplasty was performed after traversing through the arterial obstruction sites using antegrade or retrograde technique .After 6 months of the surgery , the results of visual analogue scale , dorsal or plantar arterial pulse volume scores , ankle brachial index , TcPO2 , and healing of the ulcer were compared to preoperative measures. Results Technical success was achieved in 9 cases (11 legs).During follow-up, 1 patient died of cerebrovascular events 2 months after the therapy .The other 8 cases (10 legs) were followed up for 6 months and no one had recurrent ischemic symptoms . The results of visual analogue scale , ankle brachial index, and TcPO2 before the surgery were (5.68 ±1.09) points, 0.60 ±0.04, and (25.71 ±5.25) mm Hg, which were improved to (0.44 ±0.27) points, 0.87 ±0.05, and (35.90 ±5.28) mm Hg (P<0.05).Dorsal or plantar arterial pulse volume scores were also enhanced markedly (P=0.004).Complete ulcer healing was observed in 8 limbs.No related complication was observed in other patients after the surgery .One technical unsuccessful patient who suffered infection and severe rest pain was given leg amputation . Conclusion Pedal-plantar loop technique is an effective therapy for below-the-ankle arterial occlusion while long term follow-up data need to be collected .