Outcome of percutaneous transluminal angioplasty for subacute lower limb ischemia

Context
Management of acute limb ischemia (<14 days) has been studied in a number of prospective randomized trials, and endovascular techniques, especially thrombolysis, in high-risk patients were found to be superior than open surgery. However, owing to the better results observed in patients presenting with subacute ischemia (14 days to 3 months) treated with surgery coupled with the associated complications of thrombolysis, surgery has been the recommended treatment for these patients. Patients who present with subacute ischemia have not been well recognized in the literature.
Aim
The aim of this study was to evaluate the clinical and hemodynamic outcome of percutaneous transluminal angioplasty for subacute lower limb ischemia.
Settings and design
A total of 22 limbs that presented with subacute leg ischemia admitted to Alexandria Main University Hospital have been studied prospectively. All patients had femoro-popliteal occlusions shown by multislice computed tomographic angiography and severe leg ischemic pain +/− crippling claudication. Patients with acute leg ischemia or extensive foot necrosis necessitating amputation were excluded from the study.
Patients and methods
All patients were subjected to ankle-brachial index (ABI) measurement, color duplex ultrasound (CDU) scan, and multislice computed tomographic angiography before intervention. Percutaneous transluminal angioplasty (balloon angioplasty +/− stent deployment) was performed for all participants. Clinical follow-up with ABI measurement was done at 1-, 3-, and 6-month intervals. CDU after 6 months for patency and restenosis was performed.
Statistical analysis
Statistical Package for the Social Sciences, version 15.0 was used. Values were compared with a paired samples test. values less than 0.05 were considered significant.
Results
Mean follow-up period was 6.2 months. The mean (±SD) ABI before and at 1-, 3-, and 6-month interval was 0.4 (±0.2), 0.53 (±0.11), 0.62 (±0.12), and 0.86 (±0.16), respectively, with value less than 0.0001. Limb salvage rate for those patients who had constant ischemic pain and had primary technical success was 89%. As for those patients who had severe claudication, at 6-month follow-up, they had no complaint. Primary patency rate by CDU was 95%.
Conclusions
Balloon angioplasty is a safe and effective tool for management of subacute leg ischemia. It avoids high surgical risks and carries promising patency and limb salvage rates.