ABSTRACT
PURPOSE: To evaluate the technical success and clinical long-term effectiveness of percutaneous transluminal angioplasty (PTA) of the infrapopliteal arteries in critical limb ischemia (CLI) and to determine if total vessel dilation (TVD) increases the limb salvage rate (LSR). MATERIALS AND METHODS: A retrospective study was performed in 90 consecutive patients (35 men and 55 women, median age 79 years, standard deviation [SD] 9 years) over a 5.5-year period to determine the effectiveness of infrapopliteal PTA in treating CLI. Of 90 patients, 61 underwent TVD. Analysis of LSR was performed using the Kaplan-Meier life-table analysis. RESULTS: In 90 limbs, there were 57 infrapopliteal stenoses and 104 occlusions. Including 10 technical failures (TF) (TF = 11%), LSR at 1 year and 3 years for all 90 patients with previously untreated lesions was 78%. For 80 technically successful (TS) procedures (TS = 89%), LSR at 1 year and 3 years was 87%. At 1 year and 3 years, LSR for the 61 patients who had TVD was 89%. In all patients, there were no amputations after the first year. The 30-day mortality rate was 7%. CONCLUSIONS: PTA of the infrapopliteal arteries appears to be an effective treatment for patients with CLI. TVD provides an improved LSR and warrants additional evaluation.
Subject(s)
Angioplasty/mortality , Angioplasty/methods , Ischemia/mortality , Ischemia/surgery , Leg/blood supply , Limb Salvage/mortality , Popliteal Artery/surgery , Aged , Humans , Ischemia/diagnostic imaging , Longitudinal Studies , Netherlands/epidemiology , Popliteal Artery/diagnostic imaging , Prevalence , Radiography , Risk Assessment , Risk Factors , Survival Analysis , Survival Rate , Treatment OutcomeABSTRACT
A 30 year old man with a history of migraine presented at the neurology outpatient clinic with hypesthesia of the left side of his body during a migraine attack, which was unusual for him. His family history was positive for Rendu-Osler-Weber syndrome. MRI and magnetic resonance angiography (MRA) of the brain showed multiple small infarcts, without vascular malformations. CT angiography revealed an arteriovenous fistula in the lung. Rendu-Osler-Weber syndrome (or hereditary haemorrhagic telangiectasia, HHT) is an autosomal dominant condition affecting the blood vessels. It is estimated that about 60-80% of the patients with a pulmonary arteriovenous malformation (AVM) have HHT. Neurological complications include cerebral infarction and brain abscess. Also, there is a higher prevalence of migraine in patients with HHT, although the role that HHT plays in the pathogenesis of migraine is unclear. The treatment of choice of pulmonary AVM is endovascular treatment, with a success rate of 75% in the long term.
