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24. Factors affecting patency of subintimal infrainguinal angioplasty in patients with critical lower limb ischemia

Author

Lazaris, A. M. Salas, C. Tsiamis, A. C. Vlachou, P. A. and Bolia, A. Fishwick, G. Bell, P. R.

Abstract

Background. Because subintimal angioplasty (SA) is a technique that can achieve recanalization of long arterial occlusions, it is considered an alternative to lower limb bypass operations. The aim of this prospective study was to identify the risk factors that affect potency of SA in patients suffering from critical limb ischemia (CLI). Methods and results. 51 consecutive infrainguinal SA were done in 46 patients suffered from CLI. The patients were followed-up with regular duplex scans up to 12 months post-intervention. Sex, atherosclerosis risk factors, and some technical details of the procedure (number of patent ran-off vessels after the procedure, length and re-entry point of angioplasty) were examined as potential risk factors of patency, using survival analysis statistical techniques. The overall patency rate at 12 months post-intervention was 50%. According to Cox-regression analysis, the factors that affect patency were the number of run-off vessels and the length of occlusion. Patients with two or three run-off vessels had a hazard of occlusion of 0.30 (P = .027) compared to those who had one rim-off vessel. The 12-months patency in patients with more than one non-off vessels was 81% vs. 25% in patients with one run-off vessel. Regarding the length of angioplasty, the hazard of reocclusion was 1.02 for every centimeter of occlusion (P = .049). Conclusions. The number of patent run-off crural vessels after the angioplasty and the length of occlusion are significant risk factors for reocclusion of infrainguinal SA in patients with CLI. Trying to recanalize more than one run-off vessels could raise the SA potency.

Published
2006

25. Complications following peripheral angioplasty

Author

Axisa, B., Fishwick, G., Bolia, A., Thompson, M. M., London, N. J. M., Bell, P. R. F., and Naylor, A. R.

Subjects
Male, Peripheral Vascular Diseases, Reoperation, Salvage Therapy, Hematoma, Leg, Medical Audit, Angioplasty, Hemorrhage, Intermittent Claudication, Middle Aged, Amputation, Surgical, Postoperative Complications, Treatment Outcome, Ischemia, Bronchopneumonia, Humans, Female, Prospective Studies, Emergencies, Research Article
Abstract

BACKGROUND: Peripheral angioplasty is increasingly the first choice intervention in patients with peripheral vascular disease. The aim of the current study was to audit prospectively all major complications, especially the requirement for emergency surgical intervention. PATIENTS AND METHODS: A prospective audit of outcome after peripheral angioplasty in 988 patients undergoing 1377 interventional procedures between 1 October 1995 and 30 September 1998 at which 1619 vessel segments were angioplastied. RESULTS: Major medical morbidity (bronchopneumonia, stroke, renal failure, myocardial infarction) complicated 33/1377 procedures (2.4%). Emergency surgical intervention was required after 31/1377 procedures (2.3%) with the commonest aetiologies being acute limb ischaemia and haemorrhagic complications. The amputation rate following angioplasty was 0.6% and no patient presenting with claudication or graft complications underwent amputation. The amputation rate following angioplasty for critical limb ischaemia was 2.2%. Overall, the risk of death and/or major medical complication and/or requiring emergency surgical intervention was 3.5%. The rate of complications was no different for subintimal as opposed to transluminal angioplasties. CONCLUSIONS: Peripheral angioplasty is associated with a low risk of major medical and surgical complications.

Published
2002

33. Vascular 18

Author

Loftus, I., primary, Papavassiliou, V., additional, Bolia, A., additional, Fishwick, G., additional, Naylor, A.R., additional, London, N., additional, Bell, P., additional, and Thompson, M.M., additional

Published
2002
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