| Title | Infrapopliteal angioplasty for limb salvage in the setting of renal failure: do results justify its use? | | Author(s) | Aulivola B, Gargiulo M, Bessoni M, Rumolo A, Stella A | | Institution | Division of Vascular Surgery, Department of Surgery, Loyola University Medical Center, 2160 South First Avenue, EMS Building 110, Room 3216, Maywood, IL 60153, USA. baulivola@lumc.edu | | Source | Ann Vasc Surg 2005 Nov; 19(6):762-8. | | MeSH | Adult
Aged
Aged, 80 and over
Angioplasty
Arterial Occlusive Diseases
Diabetic Nephropathies
Female
Humans
Ischemia
Kidney Failure, Chronic
Leg
Leg Ulcer
Limb Salvage
Male
Middle Aged
Popliteal Artery
Treatment Outcome
| | Abstract | Multiple reports advocate the use of infrapopliteal angioplasty for limb salvage; however, its utility in the setting of renal failure is unclear. We performed angioplasty, rather than bypass, for tibial stenoses or occlusions <3 cm on 90 limbs of 79 patients (64.4% male, mean age 67.2 years), all with ischemic ulcer. Seventy (77.8%) had diabetes mellitus and 16 (17.8%) had end-stage renal disease (ESRD). Mean follow-up was 14.3 months (range 0.3-45). Associated femoropopliteal revascularization was required in 28 (31.0%) limbs. Primary angiographic success was achieved in 83 (92.2%) limbs. Residual stenosis or thrombosis occurred in two and five limbs, respectively. Dissection occurred in six limbs, all successfully treated with stent placement. Ulcer healing occurred after initial angioplasty in 41 (55.4%) non-ESRD and four (25%) ESRD limbs. Subsequent revascularization procedures were required in 21 (23.3%) limbs, including six bypasses and 15 repeat angioplasties, of which three underwent subsequent bypasses. Major amputation was required in 11 (14.9%) non-ESRD and seven (43.7%) ESRD limbs. Limb salvage was 84.4% and 80.2% in those without and 52.5% and 52.5% in those with ESRD at 1 and 3 years, respectively (p = 0.01). Thirty-day mortality was 2.2%. Overall actuarial survival was 82.2% and 62.1% at 1 and 3 years, respectively, and did not differ significantly between patients with and without ESRD (p = 0.66). Infrapopliteal angioplasty is a safe technique with low procedural morbidity and mortality. However, the inferior wound-healing and limb-salvage rates observed in patients with renal failure bring to question the utility of infrapopliteal angioplasty in this population. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 16228808 |
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