Efficacy of multiple arterial levels of percutaneous transluminal angioplasty on limb salvage

Background: Hemodialysis access–induced distal ischemia consists of symptomatic extremity malperfusion after vascular access creation. It is usually caused by discordant vascular resistance, with arteriovenous shunting of a high blood volume from arterial into venous system and subsequent hand hypoperfusion. Less often, hemodialysis access–induced distal ischemia is caused by arterial stenosis. In these cases, access frequently has normal/low flow, radial pulse is usually absent and not recoverable with vascular access digital compression, diabetes is often present, and percutaneous transluminal angioplasty can be critical for access and limb salvage. Methods: Retrospective study conducted between June 2011 and February 2018 of patients with vascular access submitted to arterial percutaneous transluminal angioplasty for limb-threatening ischemia. Results: Twenty-nine patients were referred for arterial angiography after hemodialysis access–induced distal ischemia diagnosis and physical examination or ultrasound findings suggestive of arterial disease. In 11 patients, percutaneous transluminal angioplasty was not technically feasible. Among 18 treated patients, 83.3% had diabetes and 60% had skin ulcerations. Target arteries were radial (11), brachial (7), axillar (2), ulnar (2), and subclavian (1). Clinical success, defined as arteriovenous maintenance and wound healing/pain resolution, was observed in 12 patients (66.7%). Concomitant procedures included adjuvant banding ( n = 2) and finger amputation ( n = 1), and one reintervention was performed. No intra- or postoperative complications were reported. Conclusion: Hemodialysis access–induced distal ischemia is a serious complication of hemodialysis vascular access, with multifactorial etiology. Correct and timely diagnosis is crucial for maintaining access and limb salvage. Percutaneous transluminal angioplasty is a minimally invasive procedure that may be effective and long-lasting in carefully selected patients with ischemic complaints.

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INFRAPOPLITEAL PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY FOR LIMB SALVAGE

Acta Radiologica ◽

10.1034/j.1600-0455.2000.041001073.x ◽

2000 ◽

Vol 41 (1) ◽

pp. 73-77

Author(s):

L. Boyer ◽

T. Therre ◽

J. M. Garcier ◽

N. Perez ◽

A. Ravel ◽

...

Keyword(s):

Limb Salvage ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Percutaneous Transluminal

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Endovascular Treatment of Thromboangiitis Obliterans (Buerger’s Disease)

Vascular and Endovascular Surgery ◽

10.1177/1538574417744085 ◽

2017 ◽

Vol 52 (2) ◽

pp. 124-130 ◽

Cited By ~ 5

Author(s):

Mohammad-Hadi S. Modaghegh ◽

Shahab Hafezi

Keyword(s):

Clinical Response ◽

Limb Salvage ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Thromboangiitis Obliterans ◽

Technical Failure ◽

Rest Pain ◽

Buerger’S Disease ◽

Buerger's Disease ◽

Percutaneous Transluminal

Purpose: When critical limb ischemia (CLI) occurs in patients with thromboangiitis obliterans (TAO) or Buerger’s disease, smoking cessation alone may be insufficient to relieve rest pain and promote wound healing. Accordingly, adjunctive measures are warranted to restore adequate blood flow required for limb salvage. This study aimed to evaluate the feasibility and efficacy of percutaneous transluminal angioplasty (PTA) for the treatment of patients with TAO and CLI. In addition, a review of the literature on endovascular management of TAO is included. Methods: Between April 2012 and June 2017, all patients with TAO and CLI who underwent PTA were studied retrospectively. Patient demographics, presentation, procedural details, and clinical response were recorded. Patients were monitored at 1 week, 1, 2, 3, and 6 months after revascularization and at least every 6 months thereafter. Results: Thirteen patients with TAO and CLI, who presented with rest pain only (n = 1), ischemic ulcer (n = 4), or gangrene (n = 8) underwent endovascular interventions with primary and assisted primary technical success of 85% and 92%, respectively. A below-knee amputation was eventually done in the only patient with technical failure (limb salvage rate: 92%). Following the procedures, 11 patients had clinical response, one of whom also received intra-arterial vasodilator to achieve complete symptom relief. The other patient who failed PTA underwent a successful lumbar sympathectomy. In addition, all ulcers healed and eight minor amputations were performed due to already established gangrene. During follow-up (mean: 19.4 months), four patients needed reintervention. Patients who continued to smoke experienced more severe ischemia ( P = .017) and were more likely to require reintervention ( P = .009). Conclusion: Percutaneous transluminal angioplasty can be considered as a technically feasible and potentially effective treatment for patients with TAO and CLI, as well as a last resort for limb salvage when other options have failed. However, reintervention may be required, especially in patients who continue smoking.

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Femoropopliteal percutaneous transluminal angioplasty for limb salvage

Journal of Vascular Surgery ◽

10.1067/mva.1988.avs0080292 ◽

1988 ◽

Vol 8 (3) ◽

pp. 292-299 ◽

Cited By ~ 2

Author(s):

Mark A. Milford ◽

Fred A. Weaver ◽

Caroline J. Lundell ◽

Albert E. Yellin

Keyword(s):

Limb Salvage ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Percutaneous Transluminal

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Percutaneous transluminal angioplasty of tibial arteries for limb salvage

CardioVascular and Interventional Radiology ◽

10.1007/bf02733924 ◽

1992 ◽

Vol 15 (4) ◽

pp. 211-216 ◽

Cited By ~ 43

Author(s):

Marwan H. Saab ◽

Douglas C. Smith ◽

Paul K. Aka ◽

Robert W. Brownlee ◽

J. David Killeen

Keyword(s):

Limb Salvage ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Tibial Arteries ◽

Percutaneous Transluminal

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Infra‐inguinal percutaneous transluminal angioplasty for limb salvage: a retrospective analysis in a single center

Acta Radiologica ◽

10.1080/02841850510022705 ◽

2005 ◽

Vol 46 (2) ◽

pp. 155-162 ◽

Cited By ~ 22

Author(s):

E. Eskelinen ◽

A. Albäck ◽

W‐D. Roth ◽

K. Lappalainen ◽

P. Keto ◽

...

Keyword(s):

Multivariate Analysis ◽

Limb Salvage ◽

Percutaneous Transluminal Angioplasty ◽

Survival Rates ◽

Transluminal Angioplasty ◽

Tissue Loss ◽

Secondary Patency ◽

Risk Of Death ◽

Percutaneous Transluminal ◽

Toe Pressure

Purpose: To review the feasibility of infra‐inguinal angioplasty in the management of critical limb ischemia (CLI). Material and Methods: Data on 221 patients with 230 critically ischemic limbs, treated with consecutive percutaneous transluminal angioplasty (PTA) at Helsinki University Central Hospital between January 2000 and December 2002 were collected and analyzed retrospectively. Patency, limb salvage, and survival rates were calculated on an intention‐to‐treat basis. Comparisons were done with univariate (Kaplan‐Meier) and multivariate analysis (Cox regression). Results: Overall primary patency, secondary patency, limb salvage, and survival rates were 47%, 59%, 92%, and 76%, respectively, at 12 months. In the multivariate analysis, low toe pressure (⩽30 mmHg) was a significant risk factor for poor patency. Uremia with hemodialysis, low toe pressure (⩽30 mmHg), and hemodynamic failure of the endovascular procedure were found to increase significantly the risk of amputation. Uremia with hemodialysis, coronary artery disease, tissue loss as indication for PTA (Fontaine stage IV), and age over 70 years were all found to increase significantly the risk of death. Conclusion: Infra‐inguinal PTA is feasible in patients with CLI and resulted in good limb salvage.

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Femoropopliteal percutaneous transluminal angioplasty for limb salvage

Journal of Vascular Surgery ◽

10.1016/0741-5214(88)90281-9 ◽

1988 ◽

Vol 8 (3) ◽

pp. 292-299 ◽

Cited By ~ 25

Author(s):

Mark A. Milford ◽

Fred A. Weaver ◽

Caroline J. Lundell ◽

Albert E. Yellin

Keyword(s):

Limb Salvage ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Percutaneous Transluminal

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Percutaneous Transluminal Angioplasty for Limb Salvage — Progress in Therapy for Severe Leg Ischemia With Rest Pain and Gangrene

Percutaneous Transluminal Angioplasty ◽

10.1007/978-3-642-69278-9_36 ◽

1983 ◽

pp. 222-226 ◽

Cited By ~ 3

Author(s):

E. Schneider ◽

A. Grüntzig ◽

A. Bollinger

Keyword(s):

Limb Salvage ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Rest Pain ◽

Percutaneous Transluminal ◽

Leg Ischemia

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Percutaneous Transluminal Angioplasty in the Treatment of Critical Limb Ischemia

Journal of Endovascular Therapy ◽

10.1177/152660280301000220 ◽

2003 ◽

Vol 10 (2) ◽

pp. 298-303 ◽

Cited By ~ 37

Author(s):

Kevin J. Molloy ◽

Akhtar Nasim ◽

Nick J.M. London ◽

A. Ross Naylor ◽

Peter R.F. Bell ◽

...

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Percutaneous Transluminal Angioplasty ◽

Limb Ischemia ◽

Major Amputation ◽

Transluminal Angioplasty ◽

Table Analysis ◽

A Prospective Study ◽

Percutaneous Transluminal

Purpose: To assess the role of percutaneous transluminal angioplasty (PTA) to treat critical limb ischemia (CLI) and to relate the changing experience with endovascular treatment of this condition in a major vascular unit. Methods: A prospective study was performed involving 110 consecutive patients (57 women; mean age 76 years, range 57–99) undergoing balloon angioplasty for critical limb ischemia in 133 limbs. Outcome at 1 year was examined by case note review or questionnaire to determine survival, amputation-free survival, limb salvage, and CLI recurrence. Results: Technical success was achieved in 105 (79%) of 133 limbs; the overall complication rate was 20% (3.8% major, 16.2% minor). The median follow-up was 15 months (minimum 12). The 12-month limb salvage rate by life-table analysis was 88%. Patients with an initially successful angioplasty had an extremely good outcome (95% 1-year limb salvage). In contrast, the 28 patients with failed angioplasty fared very poorly; a major amputation was required in 10, and death occurred in another 9, leaving only 9 survivors with limbs intact at 1 year. Conclusions: The results of this study justify the continuing use of PTA as first-line treatment for critical limb ischemia.

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