Infrapopliteal balloon angioplasty for chronic critical limb ischemia in diabetic patients with uremia: when is it worth the effort?

摘要

PURPOSE: To assess the utility of infrapopliteal percutaneous transluminal angioplasty (PTA) in diabetic patients with end-stage renal disease and chronic critical limb ischemia. MATERIALS AND METHODS: Between 1994 and 2003, 20 consecutive diabetic patients with uremia (mean age, 59 years; age range, 39-73 years) underwent infrapopliteal PTA (total of 26 limbs). Additional infrainguinal lesions were treated in 12 limbs. Three limbs (12%) were classified as having Rutherford category 4 ischemia, 19 (73%) as having category 5 ischemia, and four (15%) as having category 6 ischemia. The mean length of the 58 treated infrapopliteal lesions was 8.8 cm. RESULTS: Angiographic success (<30% residual stenosis) was achieved in 22 of the 26 limbs (85%) and primary clinical success (at least one Rutherford category improvement) was achieved in nine (35%). One major complication was encountered. PTA was successful in producing a patent artery to the ankle level in 18 limbs. Primary clinical success was achieved in eight of those 18 limbs (44%) versus only one of the eight limbs (13%) with no patent artery after angioplasty (P = .01). When including the four repeated interventions, the clinical patency at 1 year (based on physical findings) was 38% (10 of 26 limbs). The rate of major amputations at 3, 6, and 12 months was 23%, 31%, and 35%, respectively, with a tendency of increased frequency among patients treated for more severe ischemia (Rutherford 4 vs 5 vs 6, P = .10). CONCLUSIONS: In diabetic patients with uremia, infrapopliteal PTA should be restricted to limbs without extensive tissue loss with lesions estimated to facilitate accomplishment of at least one patent artery to the ankle level.