J Korean Soc Radiol.  2011 Sep;65(3):217-228.

Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

• Song JH
• Lee SJ
• Jung HD
• Lim JH
• Chang NK
• Lee KB
• Yim NY
• Kim JK

Abstract

PURPOSE
To assess the efficacy of percutaneous transluminal angioplasty (PTA) in patients with infrapopliteal arterial disease, and to determine the influencing factor for prognosis.
MATERIALS AND METHODS
A total of 55 patients (60 limbs) with infrapopliteal arterial stenosis or occlusion underwent PTA. Atherosclerotic risk factors, clinical symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and vascular wall calcification were evaluated before PTA. The number of patent infrapopliteal arteries was estimated, and the outcome was evaluated by symptom relief and limb salvage.
RESULTS
Technical success was achieved in 53/60 limbs (88.3%) and 81/93 arteries (87.1%), TASC classification (p = 0.038) and vascular calcification (p = 0.002) influenced on technical failure. During follow-up, 26 of 55 limbs (47%) achieved symptom relief and 42/55 limbs (76%) underwent limb salvage. Non-diabetic patients (9/12, 75%) were superior to diabetic patients (17/43, 40%) in terms of symptom relief (p = 0.024). TASC classification and vascular wall calcification influenced on symptom relief and limb salvage. The number of patent infrapopliteal arteries after PTA influenced symptom relief (p < 0.001) and limb amputation (p = 0.003).
CONCLUSION
PTA in patients with chronic critical limb ischemia is worthwhile as a primary treatment. The influence factors should be considered before PTA, and PTA should be performed in as many involved arteries as possible.

MeSH Terms

Amputation
Angioplasty
Arteries
Atherosclerosis
Consensus
Constriction, Pathologic
Diabetic Foot
Extremities
Follow-Up Studies
Humans
Ischemia
Limb Salvage
Lower Extremity
Peripheral Arterial Disease
Risk Factors
Vascular Calcification

Figure

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  Fig. 1 Flow chart shows patient selection process and outcome of PTA. Note.-PTA = percutaneous transluminal angioplasty, TASC = TransAtlantic Inter-Society Consensus

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  Fig. 2 A 77-year-old man with pain in left leg, had diabetes mellitus. A. Pre-PTA angiogram shows a multifocal stenosis and occlusion in left posterior tibial artery (black arrow) and left anterior tibial artery (black arrowhead). B, C. PTA for left posterior tibial artery (B) and left anterior tibial artery (C) were done, respectively. D. Post-PTA angiogram shows successful recanalization of left posterior tibial artery (black arrow) and left anterior tibial artery (black arrowhead). Note.-PTA = percutaneous transluminal angioplasty

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  Fig. 3 A 59-year-old man with claudication in left leg, had diabetes mellitus and hypertension. A. Contrast enhanced CT images at pre-PTA show a total occlusion in mid portion of left posterior tibial artery (white arrow), and patent left peroneal artery (black arrow) and left anterior tibial artery (white arrowhead). B. CT angiogram with volume-rendered 3D reconstruction at pre-PTA shows that a total occlusive lesion in left posterior tibial artery doesn't contain calcification of vascular wall. C. Pre-PTA angiogram shows a total occlusion in mid portion of left posterior tibial artery (white arrow). D. Post-PTA angiogram shows successful recanalization of left posterior tibial artery (white arrow) with good distal runoff. Note.-PTA = percutaneous transluminal angioplasty

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  Fig. 4 A 62-year-old man with necrosis of left 5th toe, had diabetes mellitus, hypertension, and chronic renal failure. A, B. Pre-contrast enhanced CT axial image (A) and volume-rendered 3D reconstruction CT angiogram (B) show significant multifocal vascular wall calcifications in left anterior tibial artery (white arrow), left posterior tibial artery (black arrow), and left peroneal artery (white arrowhead). C. Pre-PTA angiogram shows multifocal luminal stenosis in left anterior tibial artery (white arrow). D. Post-PTA angiogram shows technical failure of PTA for anterior tibial artery (white arrow). Note.-PTA = percutaneous transluminal angioplasty

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