Print this pagePercutaneous Intervention As A Primary Treatment For Chronic Limb Ischemia
New York Presbyterian Hospital, Weill Medical College of Cornell University, New-York, NY
Purpose: Percutaneous intervention has been considered secondary or adjunctive therapy for lower limb revascularization. This study analyzed a policy of using percutaneous intervention as primary treatment for chronic limb ischemia.
Methods: 251 lesions (148 occlusions, 103 stenosis >70%) were treated percutaneously in 186 patients (110 men) with chronic limb ischemia between 2001 - 2004. Indications were disabling claudication 55%, rest pain 9%, tissue loss 36%. Demographics were: mean age 72 years (range: 53-92); CAD 61%; DM 52%; HTN 75%; COPD 7%; CRI 10%; tobacco 36%. Transluminal or subintimal angioplasty was performed alone (86 lesions- 45 femoral, 24 popliteal, 17 tibial) or with concomitant nitinol stent placement (165 lesions- 106 femoral, 51 popliteal, 8 tibial). A contralateral approach was used in 106 and an ipsilateral in 80. Patients were followed with physical exam, ABI and Duplex every three months.
Results: Percutaneous intervention was anatomically successful in 97% of patients. Failure resulted from inability to cross the lesion or to re-enter the true lumen distally. For patients with claudication, percutaneous treatment resulted in minimal (10%), moderate (29%) or marked (57%) improvement. After intervention the mean ABI improved from 0.43 ± 0.14 to 0.92 ± 0.15 (p<0.001). ABI increased > 0.10 in 72% of patients. Primary patency at 3, 6, and 9 months were 92%, 88%, and 80%; limb salvage for patients with limb-threatening ischemia was 87% at 9 months (figure). Mean follow-up was 10.2 months (range 1 to 36). Complications were hematoma (4%), seroma (2%), thrombosis (1%) and contrast nephropathy (1%). Incomplete wound healing was noted in 8/67. 5% of patients required subsequent bypass however, no limbs or target vessels were lost due to attempted percutaneous treatment.
Conclusion: Percutaneous intervention is safe and feasible as primary therapy for chronic limb ischemia and does not adversely affect the potential for subsequent bypass.
