Completion duplex ultrasound predicts early graft thrombosis after crural bypass in patients with critical limb ischemia

This study analyzed clinical success, patency, and limb salvage after endovascular repair in patients treated for chronic limb ischemia presenting with claudication versus critical limb ischemia. Between October 2001 and August 2004, 115 patients (mean age 71) underwent endovascular treatment for infrainguinal arterial disease. Techniques included subintimal angioplasty and transluminal angioplasty with or without stents. Lesions were classified according to Transatlantic InterSociety Consensus. Follow-up (mean 11 months) included physical exam, ankle-brachial index, and duplex ultrasound. Patency rates were determined using Kaplan-Meier and compared by log-rank analysis. One hundred ninety-nine lesions were treated in 121 limbs using percutaneous techniques. Comorbidities were similar except higher rates of diabetes mellitus (67% vs 41%, P < 0.001) and chronic renal insufficiency (22% vs 7%, P < 0.05) were found in critical limb ischemia patients. Primary patency for claudicants was 100 per cent, 98 per cent, and 85 per cent at 3, 6, and 12 months and 89 per cent, 80 per cent, and 72 per cent for critical limb ischemia, respectively ( P = 0.06). Limb salvage was 91 per cent at 12 months for critical limb ischemia patients. Morbidity was similar between groups, and there was no perioperative mortality. Percutaneous intervention for both claudication and critical limb ischemia provides acceptable 12-month patency with limited morbidity.

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Balloon Angioplasty in Chronic Critical Limb Ischemia: Factors Affecting Clinical and Angiographic Outcome

Journal of Endovascular Therapy ◽

10.1177/152660280200900403 ◽

2002 ◽

Vol 9 (4) ◽

pp. 403-410 ◽

Cited By ~ 30

Author(s):

Hannes Balmer ◽

Felix Mahler ◽

Dai-Do Do ◽

Jürgen Triller ◽

Iris Baumgartner

Keyword(s):

Balloon Angioplasty ◽

Critical Limb Ischemia ◽

Duplex Ultrasound ◽

Limb Ischemia ◽

Target Lesion ◽

Major Amputation ◽

Factors Affecting ◽

Chronic Critical Limb Ischemia ◽

Endpoint Event ◽

Artery Disease

Purpose: To assess factors that affect clinical and angiographic outcome in chronic critical limb ischemia (CLI) 12 months after primary, technically successful balloon angioplasty (BA) in infrainguinal arteries. Methods: Sixty consecutive patients (37 women; mean age 75 ± 10 years, range 53–99) with technically successful BA in 66 limbs were followed for 12 months or until death, for major amputation, or repeat target lesion revascularization (TLR). Assessment at baseline and 1 day and 12 months after BA or at an endpoint event, if feasible, was performed with angiography or duplex ultrasound (above-knee revascularization only). Mortality, limb prognosis, and restenosis rate were correlated with cardiovascular risk factors, hemodynamic measures, and angiographic features. Results: Mortality was 25% at 1 year; compared to survivors, nonsurvivors more often had coronary artery disease (93% versus 44% for survivors, p<0.001), bilateral CLI (60% versus 29%, p=0.033), and higher fibrinogen levels (5.1 g/L versus 4.3 g/L, p=0.049). CLI resolved in more than half (35, 53%) of the limbs without repeat TLR. The major amputation rate was 6%. Limb prognosis correlated with ankle pressures after BA. Restenosis rates were 65% at the femoropopliteal and 56% at the infrapopliteal level (NS); these correlated with the length of the treated arterial segment (8.7 cm with restenosis versus 4.0 cm without, p<0.001). Conclusions: High mortality in CLI was associated with an extensive, clinically manifest arteriosclerotic process and high fibrinogen levels. Limb prognosis and restenosis after BA were primarily influenced by local hemodynamic and technical factors. Despite considerable restenosis, more than 90% of survivors avoided major amputations.

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One-Year Outcomes of the Paclitaxel-Eluting, Self-Expanding Stentys Stent System in the Treatment of Infrapopliteal Lesions in Patients With Critical Limb Ischemia

Journal of Endovascular Therapy ◽

10.1177/1526602817697319 ◽

2017 ◽

Vol 24 (3) ◽

pp. 311-316 ◽

Cited By ~ 6

Author(s):

Marc Bosiers ◽

Joren Callaert ◽

Koen Keirse ◽

Jeroen M. H. Hendriks ◽

Patrick Peeters ◽

...

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Duplex Ultrasound ◽

Limb Ischemia ◽

Target Lesion ◽

Primary Patency ◽

Drug Eluting Stent ◽

Lesion Length ◽

Imaging Data ◽

Stent System

Purpose: To investigate the efficacy of the paclitaxel-coated, self-expanding, nitinol Stentys Stent System in tibioperoneal lesions ≤50 mm long. Methods: The prospective, single-arm, multicenter PES-BTK-70 trial ( ClinicalTrials.gov identifier NCT01630070) evaluated the safety and efficacy of the coronary Stentys Stent System in the treatment of a stenotic or occlusive lesion ≤50 mm long in the tibioperoneal arteries of patients with critical limb ischemia (CLI). Between January 2012 and May 2013, 70 patients (mean age 74.6±9.4 years; 45 men) with CLI [Rutherford category 4 (37, 52.9%) or 5 (33, 47.1%)] received a Stentys drug-eluting stent for the treatment of infrapopliteal stenosis (60, 85.7%) or occlusion (10, 14.3%). The mean lesion length was 17.2 mm (4.0–58.5). The primary outcome measures were primary patency at 6 months (duplex ultrasound) and 12 months (angiography). Secondary outcomes included limb salvage and freedom from target lesion revascularization (TLR). Kaplan-Meier estimates of the outcomes are given with the 95% confidence intervals (CI). Results: Technical and procedure success (<30% residual stenosis without major complications) was achieved in 68 (97.1%) of 70 cases. Primary patency was 87.6% (95% CI 83.5% to 91.7%) at 6 months and 72.6% (95% CI 66.9% to 78.3%) at 1 year. Freedom from TLR was 79.1% at 1 year (95% CI 73.9% to 84.3) and limb salvage was 98.5% (95% CI 97.0 to 100.0). No stent fractures were found by core laboratory review of all follow-up imaging data available up to 12 months. Conclusion: In this study, the self-expanding, nitinol, paclitaxel-eluting, coronary Stentys stent was found to be safe and effective in the below-the-knee region, with results similar to the most recent limus-eluting stent trials.

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Midterm Outcomes After Infrapopliteal Interventions in Patients With Critical Limb Ischemia Based on the TASC II Classification of Below-the-Knee Arteries

Journal of Endovascular Therapy ◽

10.1177/1526602817704643 ◽

2017 ◽

Vol 24 (3) ◽

pp. 321-330 ◽

Cited By ~ 11

Author(s):

Gagan D. Singh ◽

Ellen K. Brinza ◽

Justin Hildebrand ◽

Stephen W. Waldo ◽

T. Raymond Foley ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Velocity Ratio ◽

Peak Systolic Velocity ◽

Duplex Ultrasound ◽

Limb Ischemia ◽

Vessel Diameter ◽

Primary Patency ◽

Tissue Loss ◽

Success Rates ◽

Chronic Total Occlusions

Purpose: To analyze the relationship between the new TransAtlantic Inter-Society Consensus (TASC II) infrapopliteal classification and limb outcomes among patients with critical limb ischemia (CLI). Methods: A single-center retrospective study was performed on 166 consecutive CLI patients (mean age 71 years; 113 men) undergoing endovascular treatment of 244 infrapopliteal lesions from 2006 to 2013. Patient, procedural, angiographic, and limb outcomes were compared for the new TASC A/B vs C/D classification for infrapopliteal lesions. Binary restenosis was determined by a peak systolic velocity ratio >2.0 by duplex ultrasound on follow-up at 1, 3, 6, and 12 months. Results: Seventy-two (43.4%) patients had TASC A/B lesions, while 94 (56.6%) had TASC C/D patterns of infrapopliteal disease. Baseline demographics and tissue loss (93% vs 94%, p=0.59) were similar between the groups. TASC A/B lesions were shorter (53±35 vs 170±83 mm, p<0.001), less severely stenosed (77%±24% vs 93%±14%, p<0.001), had a larger target vessel diameter (2.9±0.5 vs 2.6±0.5 mm, p<0.001), and were less frequently chronic total occlusions (24% vs 64%, p<0.001) compared with the TASC C/D group. Three-year freedom from both amputation (85% vs 67%, p=0.02) and major adverse limb events (79% vs 61%, p=0.02) were significantly higher in the TASC A/B group. Technical success rates (95% vs 80%, p<0.001) and 1-year primary patency (58% vs 51%, p=0.04) were higher in the A/B group. Overall 3-year survival was similar between the groups (96% A/B vs 88% C/D, p=0.2). Conclusion: TASC C/D infrapopliteal lesions are associated with higher amputation and major adverse limb events rates and lower primary patency compared with TASC A/B infrapopliteal lesions. Further studies are needed to assess the association between TASC C/D infrapopliteal lesions and clinical outcomes in patients with CLI.

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Preoperative visualization of peripheral arteries with duplex ultrasonography in patients with diabetes mellitus and critical limb ischemia

Diabetes Mellitus ◽

10.14341/2072-0351-3756 ◽

2013 ◽

Vol 16 (2) ◽

pp. 52-61 ◽

Cited By ~ 2

Author(s):

Olga Nikolaevna Bondarenko ◽

N L Ayubova ◽

Gagik Radikovich Galstyan ◽

Ivan Ivanovich Dedov

Keyword(s):

Diabetes Mellitus ◽

Critical Limb Ischemia ◽

Duplex Ultrasound ◽

Limb Ischemia ◽

Vascular Lesions ◽

Duplex Ultrasonography ◽

Tibial Arteries ◽

Specificity And Sensitivity ◽

Group B ◽

Data Coherence

AIM: To determine whether duplex ultrasonography (DU) without verification with diagnostic angiography (DA) is a sufficient visual- ization technique for pre-operative examination of patients with CLI (critical limb ischemia) indication for percutaneous transluminal balloon angioplasty (PTBA). MATERIALS AND METHODS: We examined 254 patients (290 limbs in total) with diabetes mellitus (DM) and CLI. All participants were subdivided into two groups: ?A? (PTBA with pre-operative DU+DA) and ?B? (PTBA with pre-operative DU). We evaluated data coherence between DU and DA (pre- or intraoperative) methods, as well as DU diagnostic specificity and sensitivity in determining degree and localization of vascular lesions. We also investigated specific clinical factors compromising DU diagnostic capabilities in patients with DM. RESULTS: Our data suggests adequate coherence between DU and DA for pre-operative visualization. Group ?B? showed significantly higher diagnostic sensitivity and specificity for visualization of the lower third of superficial femoral artery and tibial arteries despite abdominal obesity, grossly evident calcification and peripheral edema. CONCLUSION: Duplex ultrasound is efficient and precise enough to determine optimal management tactics in most patients with DMand CLI without resort to invasive methods.

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