Native artery recanalization in patients with Critical Limb Ischemia followed bypass failure
Year: 2009
Type: dissertation
Study design: Observational Study
Abstract: Introduction: At our department, limb-salvage angioplasty has been introduced as an alternativelast\nchance method with the primary goal of achieving limb salvage in selected poor surgical\ncandidates with end-stage arterial occlusive disease and with bypass failure. The purpose of this\nstudy was to evaluate the treatment outcomes after limb-salvage PTA/S for poor surgical candidate\npatients with CLI following occluded bypass and who otherwise would be candidates for primary\namputation.\nObjective: To prove the possibility of native artery recanalization in patients with critical limb\nischemia followed bypass graft failure and to evaluate the outcomes of endovascular treatment for\nlimb salvage in those critical limb ischemic patients who are otherwise would be candidates for\nmajor amputation.\nMaterials and methods: This study was a single centre experienced, retrospective clinical\nanalysis of 29 consecutive high surgical risk patients with CLI treated with PTA/Stent following\nthe failure of open surgery bypass grafts reconstruction. All patients had occlusion of previous\nbypass graft and were considered poor candidates for a new bypass operation. Preprocedural and\npostprocedural ankle-brachial index (ABI), TcPO2 and TcPCO2 were used to evaluate\nhemodynamic and tissue perfusion improvement. All patients were studied with a color-Doppler-\nUS, MR angiography, MsCT angiography as a diagnostic pre-procedure to define the location of\nlesions and to plan the revascularization strategy. Ulcers on the lower limb were photographically\nrecorded with a digital camera for core laboratory assessment. Post procedure follow-up was\nscheduled 1, 3, 6 months and yearly thereafter. The data’s were analyzed with the Student t test;\nsignificant difference was assumed for p<0.05.\nResults: The technical success was achieved in 28 (93.3%) of 30 limbs. In these 28 limbs\nsubintimal technique was incorporated in 92.8 % of cases. Mean lesion length was 12.3 ± 6.3 cm\n(4.8–29). In 7 (23.3%) limbs were positioned stent. The preprocedural level of TcPO2 was 13.8 ± 6\nmmHg; in patients with technical success this parameter was increased after first week up-to 26.83\n± 13 mmHg. (p<0.05) Preprocedural mean of TcPCO2 in extremely ischemic foot was 71.2 ± 27\nmmHg, but postprocedural mean, after first week, was decresed significantly and was continuing\nto decrease in subsequently. (p<0.001) The ABI improved to 0.86 ± 0.18 (p<0.001 versus\npretreatment) and TCO2 improvement was obtained to 52.4 ± 0.22 (p<0.001). The mean area\nreduction of ulcers or minor amputation sites was 72% for 23 wounds observed at 3 months,\nincreasing to 93% at 6 months. In the 28 successfully treated patients, the limb salvage rate at 6\nmonths was at least 92.8 %.\nConclusion: Native artery limb-salvage angioplasty can be successfully achieved in amputation\ncandidate, high surgical risk patients with critical limb ischemia followed bypass failure. The\noutcomes of our study shows that the endovascular recanalization (PTA) technique in these high\nrisk group patients is optimal alternative method of treatment with optimal technical success, with\nlow morbidity and mortality, feasible even in multiple, long and high calcify steno-occlusions of\nlimb arteries, which allows immediate clinical results and good limb salvage rate in short term\nfollow-up.
Author: Erdembileg Tsevegmid
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W102409773