Percutaneous Transluminal Angioplasty For Inferior Genicular Arterial Occlusive Disease

Purpose:Lower extremity arteriosclerosis obliterans is the most common peripheral arterial disease in our country and its incidence is increasing these years.The patients' conditions are complicate,most of them have diabetes mellitus,cardiovascular diseases,cerebrovascular diseases.They can not tolerate much trauma.Although the clinical results of the traditional surgery are approved in lower limb ischemia,the infrapopliteal artery ischemia are still tough problems in clinic,especially the diabetics who complicating infrapopliteal lesion and diabetic foot.Their lesions are extensive,with bad clinical results and high amputation rates.The purpose of this study is to evaluate the clinical results and the arterial patency of infragenicular percutaneous transluminal angioplasty(PTA).Methods:This study prospectively,nonrandom,consecutively analyzed the 71(101 limbs) patients with infrapopliteal artery ischemia treated in vascular surgery department of Tianjin Union Medicine Centre from Feb.in 2007 to Mar.in 2008.All the patients were divided into two groups according to their therapy.GroupⅠwere treated with PTA;groupⅡwere only drug treatment.Two groups were compared with each other relative to their clinical features:age,gender,course of disease, symptoms,limp distance,risk factors,ABI,clinical results,cumulative patency,etc. Statistical evaluation was performed.Significance was defined at the P＜0.05 level.Results:In our study,groupⅠhas 45(52 limbs) patients,groupⅡhas 26(49 limbs) patients.All patients' age ranged from 39 to 86 years old,and there are 49 male,22 female,no significant difference in ages and gender between the two groups.The mean course of disease was 27.94±4.69 months(range 1 month to 20years),there are significant difference in course between the two groups(P＜0.05).48.08%(25/52) of groupⅠand 14.29%(7/49) of groupⅡhad rest pain.17.31%(9/52) of groupⅠand 6.12%(3/49) of groupⅡhad gangrene or ulcer.There are significant difference in symptom between the two groups(P＜0.05).The clinical results in groupⅠwere 55.77%as "significantly improved",34.615%as "improvement",9.615%as "no change";In groupⅡthere were 20.41%as "improvement",79.59%as "no change"; no "worse" in the two groups,there was significant difference between two groups(P＜0.05).GroupⅠwas better than groupⅡ.GroupⅠhad an average pretherapy ABI of 0.34±0.04,groupⅡwas 0.46±0.05.Two weeks later,both of two groups had increased the ABI.The degrees of increase had significant difference between two groups(P＜0.05),GroupⅠwas higher than groupⅡ.In groupⅠ,there were no patient died in the therapy period.The postoperative complications was 7.69%.The arterial cumulative patency rate was 90.38%at 6 months,88.46%at 1 year,65.22%at 2years in groupⅠ.The secondary arterial patency rate was 96.15%at 6 months,96.15%at 1 year,83.33%at 2years in groupⅠ.The limb salvage rate was 100%.Conclusions:1.PTA is a safe,effective and feasible procedure for the treatment of critical infragenicular limb ischemia.2.PTA has an important and definitive role for patients with infrapopoliteal arterial occlusive disease and critical limb ischemia by easily revascularizing inflow and outflow lesions with minimal morbidity and mortality,which significantly improved distal extremity perfusion pressure.In the presence of the outflow lesions,it can provide more complete restoration of blood flow than bypass surgery,resulted in immediate relief of rest pain and enhancement of wound healing.3.Clinical recurrence of infrapopliteal PTA was infrequent and the procedure could successfully be repeated in most cases.PTA should be recommended as the first choice for all patients with critical infragenicular limb ischemia.4.With regard to patients whom suffering from Infragenicular limb ischemia,PTA is an effective therapy with minimal invasion.But as to the long term patency,we need do some further study in the future.