Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia: angiographic and clinical results.

PURPOSE: To evaluate the safety and efficacy of infrapopliteal percutaneous transluminal angioplasty (PTA) as a primary treatment of chronic critical limb ischemia in a prospective trial. MATERIALS AND METHODS: Infrapopliteal PTA was performed on 72 limbs of 60 patients (mean age, 72 y; range, 38-92 y) and patients were followed for 12-24 months. RESULTS: The primary angiographic success rate for the stenoses was 84% (102 of 121) and that for the occlusions was 61% (41 of 67) with corresponding restenosis rates of 32% and 52% at follow-up angiography performed a mean of 10 months after primary PTA. The rate of major complications was 2.8% (access site pseudoaneurysms in two patients). The primary clinical success was 63% (45 of 72). A 48% cumulative primary patency rate, a 56% secondary patency rate, and a 80% cumulative limb salvage rate were registered at 18 months, as determined with use of Kaplan-Meier analysis. Lack of angiographic improvement at the site of the most severe ischemia and renal insufficiency (serum creatinine level > 130 micromol/L) were independent predictors of poorer long-term clinical results, as determined with use of Cox multiple regression analysis. CONCLUSIONS: Infrapopliteal PTA is a feasible primary treatment of chronic critical limb ischemia with moderate primary angiographic and clinical success, a low complication rate, and a cumulative limb salvage rate comparable with surgical techniques.

Angiographic characteristics of symptomatic recurrent disease after infrainguinal percutaneous transluminal angioplasty.

PURPOSE: To evaluate the angiographic patterns of clinically manifest recurrent disease after infrainguinal percutaneous transluminal angioplasty (PTA) of stenoses and total occlusions. METHODS: Among 326 infrainguinal PTAs on 263 consecutive patients, selective angiography was performed on 61 limbs of 52 patients 1-60 months after the primary intervention because of clinically suspected recurrent disease. Lesion-specific and patient-related factors were analyzed for 75 angiographically confirmed recurrent lesions in 57 limbs of 48 patients. RESULTS: Recurrent disease was more frequently a stenosis when the original target lesion was a stenosis (92%, 44/48) than when the original lesion was a total occlusion (59%, 16/27; p < 0.001). When the original target lesion was a stenosis, the total length of the recurrent disease was longer than that of the original lesion [3.9 +/- 3.9 cm (mean +/- standard deviation) vs 2.8 +/- 2.7 cm; p = 0.03], while in the subgroup of original total occlusions the length of the recurrent lesion was shorter than that of the original occlusion (7.1 +/- 5.0 cm vs 9.9 +/- 6.9 cm; p = 0.02). Half the restenosis (22/44) extended beyond one or both ends of the original stenosis and 38% (6/16) of the reocclusions extended beyond the distal end of the original occlusion. CONCLUSIONS: The type of recurrent disease depends on the original lesion type and the restenotic lesion frequently extends beyond one or both ends of the original target lesion.

Brachial artery access for percutaneous renal artery interventions.

PURPOSE: To evaluate the suitability of transbrachial access for endovascular renal artery interventions. METHODS: During 37 consecutive endovascular renal artery interventions, the transbrachial approach was used on nine patients (mean age 63 years; range 41-76 years) for 11 renal artery procedures on native kidneys and one percutaneous transluminal angioplasty (PTA) on a transplanted kidney. The reason for using transbrachial access was a steep aorta-renal angle in five, and severe aorta-iliac atherosclerosis in the remaining patients. In addition to the intervention catheter in the left brachial artery, an additional nonselective catheter for controlling the procedure was inserted transfemorally (six patients) or via the contralateral brachial artery. RESULTS: Eleven interventions (six PTAs, five stents) were successfully completed. The one failure resulted from impenetrable subclavian artery stenosis. The only major complication was a brachial artery pseudoaneurysm requiring surgical treatment. CONCLUSION: Transbrachial access is an effective and relatively safe technique for renal artery interventions when transfemoral access is not possible.

Percutaneous transluminal angioplasty in femoral artery occlusions: primary and long-term results in 107 claudicant patients using femoral and popliteal catheterization techniques.

To assess the impact of percutaneous transluminal angioplasty (PTA) of occluded femoral arteries, a prospective study of 107 claudicant patients was performed. A total of 117 limbs were treated and were followed for 1-36 months; the mean length of treated occlusions was 7.4 cm (range 2-25 cm). Eighty-nine recanalizations were performed using antegrade femoral and 28 using the retrograde popliteal catheterization technique. With logistic regression a short length of occlusion correlated favourably with early success. Including rePTAs and applying standardized criteria, survival analysis with the Kaplan-Meier method revealed a 3-year secondary patency rate of 55% for all the treated limbs. The following factors had negative influence on primary patency after successful recanalization; presence of soft thrombotic material in the recanalized artery segment and the presence of focal dissections after PTA. In univariate and multiple logistic regression analysis, male gender and a lesser extent of the atherosclerotic disease (assessed by the number of diseased vessels in the treated limb) correlated with a lower frequency of PTA procedure complications. There was no statistically significant difference in the complications, in the primary success or in the long-term results using either the femoral or popliteal route. However, the popliteal approach improved the early success of the originally antegrade access group by 6% and increased by about one-fifth the number of patients considered technically feasible for PTA in femoral artery occlusions. PTA can be used in femoral artery occlusions up to 10 cm long and it is especially suitable in femoral artery occlusions not exceeding 5 cm in length. PTA can be tried in femoral artery occlusions exceeding a length of 10 cm if operative treatment is not suitable.