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Home > Press Center > Press Releases from 2007 Annual Meeting > Infrapopliteal Balloon Angioplasty Safe for Chronic Occlusive Disease

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Emily Kalata
Assistant Director, Communications
312.334.2309

Infrapopliteal percutaneous balloon angioplasty (PTA) used for the treatment of chronic occlusive disease such as lower extremity ischema, can be performed safely with favorable results, but primary patency is related to the extent of other diseases a patient may have. This is according to a study presented today at the 61st Annual Meeting of the Society for Vascular Surgery. 

“Use of PTA to treat crural vessels is the appropriate initial therapy for patients whose overall life expectancy is poor, although secondary interventions may be necessary to maintain clinical success,” said author Glenn M. LaMuraglia, MD, associate professor of surgery at Harvard Medical School and member of the department of vascular and endovascular surgery at Massachusetts General Hospital, Boston. 

A total of 155 primary crural vessels were reviewed in 144 patients with a mean age of 74 years. Seventy percent of the patients were male. Co-morbidity percentages included critical limb ischemia, 86; diabetes, 66; and renal insufficiency, 45. Infrapopliteal lesions were classified as TASC designations of increasing anatomic disease severity: A (7 percent), B (18 percent), C (39 percent) and D (35 percent). Primary study end points included: 1º patency, assisted patency, limb salvage and patient survival assessed by Kaplan-Meier life-table analysis. Factors predictive of failure and patient longevity were evaluated by multivariate methods.
   
PTA was confined to the infrapopliteal segment in 40 of the cases and infrapopliteal stents were placed in five patients. Concomitant above knee correction was undertaken in 85 patients in whom crural coagulation was felt to be crucial to success.

Technical success was 95 percent with a 30-day mortality of 2 percent and a major morbidity of 3 percent. Patients were followed up to 54 months (mean 22). The 40-month patency was 62 percent with assisted patency of 90 percent. Repeated infrapopliteal procedure patency was 16 percent.

Additionally, interval conversion to bypass surgery occurred in seven patients. Seventy-six of 118 patients who presented with ulcers or gangrene healed during follow-up. Major amputations occurred in 18 patients (seven for advanced wounds despite a functioning revascularization) yielding a 40-month limb salvage of 86.2 percent. 

Multivariate negative predictors of 1º patency included: vessel runoff and dialysis. Negative predictors of limb salvage included dialysis and failure to improve runoff to the foot. At 40-months, patient survival was 54 percent.    

The authors concluded that use of percutaneous angioplasty in the infrapopliteal vessels of the calf was safe and with good success in a patient population with very limited longevity of 54 percent at 3.3 years.