LOS ANGELES -- One center has had a favorable experience offering revascularization to patients with severe below-the-ankle critical limb ischemia (CLI), according to medium-term data reported here.
Individuals with Rutherford category 5 or 6 symptoms achieved inline flow recanalization to the foot 97% of the time, the marker of technical success for these procedures at Rush University Medical Center in Chicago, said Merve Ozen, MD, an interventional radiology fellow at the institution, at the Society of Interventional Radiology conference.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
The two failures that stood in the way of perfect technical success were a metatarsal artery rupture and a partial recanalization due to persistent vasospasm.
In the , follow-up lasting an average of 20.5 months demonstrated an overall limb salvage rate of 79%, according to Ozen.
During that time, there were 11 major below-the-knee amputations. On top of that, there were three cases of above-the-knee amputation.
Minor amputations planned at the time of revascularization were divided between transmetatarsal (21% of patients) and toe amputations (46%).
Among the 34 individuals who had at least 12 months of follow-up, eight had major amputations. Their limb salvage rate was 70%.
“Below-the-ankle interventions are feasible and provide good clinical outcome,†Ozen concluded, commenting to MedPage Today that clinical follow up is “very important†for continuity of care and for the prevention of major amputations.
Participants had undergone arterial revascularization for CLI at Rush in 2013-2018. Mean age was 68 and two-thirds of the group were men. In addition, Ozen noted, 79% had diabetes and 63% chronic kidney disease at presentation.
Lesions were treated with angioplasty with one in five also receiving atherectomy. Concomitant infrapopliteal and femoropopliteal intervention was performed in 57% and 39% of cases, respectively.
After the procedure, patients were prescribed clopidogrel (Plavix) and aspirin for at least 6 months.
Primary patency was 62% at 6 months and 53% at year’s end.
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Primary Source
Society of Interventional Radiology
Arslan B, et al "Midterm outcomes after below the ankle interventions for Rutherford 5-6 critical limb ischemia patients" SIR 2018.