Long-term outcome of successful percutaneous transluminal angioplasty of the fibular artery in diabetic foot syndrome and single-vessel calf perfusion depends on doppler wave pattern at the forefoot

Background: In the diabetic foot syndrome (DFS) due to peripheral artery disease, the fibular artery is often the only vessel which can be revascularised. Because the fibular artery does not have a direct connection to the plantar arch, the clinical result of fibular artery PTA is dependent upon the extent of collateralization at the ankle. Therefore, successful PTA of the fibular artery with resulting biphasic doppler waves at the ankle can lead to either biphasic or monophasic post-occlusive doppler wave patterns at the forefoot. We evaluated prospectively the association of the forefoot doppler wave form on long-term clinical outcome in patients with DFS after successful PTA of the fibular artery. Patients and methods: 44 patients with occluded calf vessels and DFS Wagner 2-4 underwent primary successful fibular artery PTA resulting in biphasic ankle doppler wave. According to doppler wave form at the forefoot, patients were divided into 1) a biphasic or 2) a monophasic group. Up to 45 months, we documented doppler wave forms, clinical course, restenosis, reinterventions, wound healing, major- and minor amputations. Results: PTA resulted in a biphasic doppler wave at the forefoot in 26 (59 %), in 18 (41 %) in a monophasic wave pattern. Biphasic forefoot doppler wave was strongly correlated with longer event-free survival (35 bi- vs. 5.5 months monophasic, p = 0.0018) and complete wound healing (69 % s bi- vs. 44 % vs. monophasic p = 0.0309). Major amputations: 2 / 26 (8 %) in the biphasic and in 3 / 18 (17 %) in the monophasic group. Second revascularisation procedures were more often necessary in the monophasic group (7 / 18 (39 % vs. 2 / 26 (8 %)). Conclusion: After successful PTA of the fibular artery, monophasic doppler wave patterns at the forefoot denote insufficient collateralization and are associated with poor outcome. If successful fibular artery PTA results only in monophasic forefoot doppler, additional crural or pedal bypass should be strongly contemplated.

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Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽

10.1024/0301-1526.31.1.36 ◽

2002 ◽

Vol 31 (1) ◽

pp. 36-42 ◽

Cited By ~ 3

Author(s):

. Bucek ◽

Hudak ◽

Schnürer ◽

Ahmadi ◽

Wolfram ◽

...

Keyword(s):

Success Rate ◽

Clinical Stage ◽

Ankle Brachial Index ◽

Clinical Situation ◽

Clinical Results ◽

Transluminal Angioplasty ◽

Term Outcome ◽

Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

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Percutaneous transluminal angioplasty of infrainguinal vein graft stenosis: Long-term outcome

British Journal of Surgery ◽

10.1002/bjs.1800820762 ◽

1995 ◽

Vol 82 (7) ◽

pp. 1003-1004

Author(s):

A. D. Houghton ◽

M. R. Tyrrell ◽

Y. Panayiotopoulos ◽

J. F. Reidy ◽

P. R. Taylor ◽

...

Keyword(s):

Vein Graft ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Term Outcome ◽

Long Term Outcome ◽

Graft Stenosis ◽

Percutaneous Transluminal

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Long-Term Outcome and Disability of Diabetic Patients Hospitalized for Diabetic Foot Ulcers: A 6.5-year follow-up study

Diabetes Care ◽

10.2337/dc07-2145 ◽

2008 ◽

Vol 31 (7) ◽

pp. 1288-1292 ◽

Cited By ~ 97

Author(s):

E. Ghanassia ◽

L. Villon ◽

J.-F. Thuan dit Dieudonne ◽

C. Boegner ◽

A. Avignon ◽

...

Keyword(s):

Diabetic Foot ◽

Foot Ulcers ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Term Outcome ◽

Long Term Outcome ◽

Follow Up Study

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Transluminal angioplasty of isolated crural arterial lesions in diabetics with critical limb ischemia

VASA ◽

10.1024/0301-1526.34.3.186 ◽

2005 ◽

Vol 34 (3) ◽

pp. 186-191 ◽

Cited By ~ 37

Author(s):

Sigala ◽

Menenakos ◽

Sigalas ◽

Baunach ◽

Langer ◽

...

Keyword(s):

Limb Ischemia ◽

Transluminal Angioplasty ◽

Tissue Loss ◽

Peroneal Artery ◽

Diabetic Patients ◽

Critical Ischemia ◽

Term Outcome ◽

Long Term Outcome ◽

Crural Arteries

Background: We investigated the long-term clinical results of transluminal angioplasty of isolated infrapopliteal arteries in diabetic patients with severe ischaemic foot lesions and the influence of different parameters on primary success, the long-term outcome and the survival rate. Patients and methods: Between January 2001 and May 2004 we performed 50 transluminal angioplasties in 52 (10 female, 42 male, mean age 69.3 years) diabetics with isolated lesions of crural arteries (tibio-peroneal trunk 41, anterior tibial 13, posterior tibial 5, peroneal artery 14) and limb threatening ischaemia (rest pain 12, tissue loss 40). In two patients the dilatation could not be performed due to vessel perforation and impossibility to catheter localization. The morphological classification of infrapopliteal lesions was determined according to guidelines provided by TransAtlantic Inter-Society Consensus (TASC) (17 type A, 16 type B, 13 type C, 4 type D). Results: Initial technical success after angioplasty of crural arteries could be obtained in 96%.Kaplan-Meier analysis showed a cumulative limb salvage of 92%,85% and 68, 9% after 6 months,one and two years, respectively. Patients falling in TASC group C had significantly higher risk of amputation. Overall survival at 1 year was calculated at 85% and at 2 years at 65%. Conclusion: Our results suggest that depending on the extent of lesions transluminal angioplasty of infrapopliteal artery stenoses and occlusions is considered as an effective and save therapy modality to avoid limb loss in diabetics with critical ischemia.

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