Limb Salvage Angioplasty in Poor Surgical Candidates

Abstract

This study was conducted to evaluate the potential for percutaneous catheter based limb salvage angioplasty in patients who have no surgical bypass option. Twenty patients, 12 males and 8 females, with end-stage limb ischemia (Rutherford category 4 and 5) were treated with balloon angioplasty. Antegrade femoral access, coronary guidewire, and balloons were used. The aim of intervention was to prevent major amputation with low morbidity and mortality. Technical success was based on intent to treat and radiologic patency after the procedure. Clinical success was based on healing of ischemic ulcers, resolution of rest pain, improvement of ankle-brachial index (ABI) > 0.10, or healing of a minor amputation site. Limb salvage is defined as preservation of functional foot without a need for prosthesis for ambulation. The mean age of the patients was 67.5 years. Mean follow-up was 8.8 months. Indications for revascularization were rest pain (2), ischemic ulcers (9), and gangrene (9). The indications for percutaneous revascularization were lack of a distal surgical target vessel in 10 (2 did not have adequate vein), poor surgical risk in 7 (1 without adequate vein), and short segment lesions in 3. Technical success was achieved in 18 (90%). One of the technical failures required a below-the-knee amputation (BKA). Clinical success was achieved in 15 patients (75%). There was 1 death due to myocardial infarction, and 4 BKAs within 6 weeks of angioplasty. Two patients had recurrent lesions within 6 months. Infra-inguinal arterial angioplasty can achieve limb salvage in patients who are at high surgical risk, or do not have good target vessels or adequate conduits for distal revascularization.