Percutaneous transluminal angioplasty in patients with ischemic tissue necrosis is worthwhile

Ischemic tissue necrosis is usually associated with long or sequential arterial obstructions. As a result, the role of percutaneous transluminal angioplasty (PTA), which addresses only short lesions, in patients presenting with trophic changes remains questionable. The purpose of this study was to evaluate the effectiveness of PTA in diabetic and non-diabetic patients presenting with grade 4 Fontaine's classification.

Between January 1992 and December 1997, 1352 patients with aorto-iliac and/or infrainguinal occlusive diseases were admitted to our institution. Three hundred and ten patients who presented with distal gangrene (95.5%) or ischemic ulcers (4.5%) were identified. The patients consisted of 117 diabetics and 193 non-diabetics. PTA alone was performed in 26 diabetics (group 1) and in 30 non-diabetics (group 2). Their charts were retrospectively reviewed and the patients were recalled for clinical examination and non-invasive monitoring.

Follow-up was available for all patients and ranged from 1 to 4 years. The survival rate was significantly higher in diabetic patients than in non-diabetic patients (96% vs 77% at 1 year; p<0.05 and 91% vs 66% at 3 years; p<0.05). In group 1, the primary cumulative patency rate at 1 and 3 years was 76%. In group 2, the primary cumulative patency rate at 1 and 3 years were 85% and 80%, respectively. Three patients in group 1 required a redo PTA at 4 months, resulting in an assisted primary patency rate at 1 and 3 years of 88%. In contrast, no patients in group 2 required additional PTA. In group 1, the limb salvage rate at 1 and 3 years was 84%; and in group 2, 80% and 75%, respectively.

The results of PTA in both groups were encouraging. Dilation of one or two short stenoses, despite multiple distal lesions, may improve distal flow sufficiently to promote wound healing. Thus, this procedure may be recommended in selected patients suffering from ischemic tissue loss. However, during the first 6 months following PTA, diabetic patients should be followed carefully with Duplex as they are prone to early restenosis.