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Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia

Marcello Romiti1, Maximiano Albers, Francisco Cardoso Brochado-Neto

  • 1Vascular Surgery Section, Department of Surgery, Health and Medical Sciences Sector, Lusiada Foundation, Santos, Sao Paulo, Brazil.

Journal of Vascular Surgery
|March 29, 2008
PubMed

Insights

Crural angioplasty offers acceptable limb salvage for chronic critical limb ischemia, comparable to bypass surgery. However, its technical success and durability are limited, necessitating further research for optimal patient treatment strategies.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Regenerative Medicine

Background:

  • Infrainguinal arterial occlusive disease is increasingly treated with percutaneous transluminal angioplasty.
  • Crural angioplasty is a key intervention for chronic critical limb ischemia.
  • Comparative outcomes with bypass surgery are crucial for treatment decisions.

Purpose of the Study:

  • To assess the mid-term outcomes of crural angioplasty in patients with chronic critical limb ischemia.
  • To compare crural angioplasty results with a meta-analysis of popliteal-to-distal vein bypass graft outcomes.

Main Methods:

  • Meta-analysis of 30 studies published between 1990 and 2006.
  • Inclusion of studies with at least 15 infrapopliteal angioplasties and 12-month patency or limb salvage data.
  • Analysis of immediate technical success, primary/secondary patency, limb salvage, and patient survival using survival analysis.

Main Results:

  • Immediate technical success rate was 89.0%.
  • 1-year primary patency was 77.4%, secondary patency 83.3%, limb salvage 93.4%, and patient survival 98.3%.
  • Outcomes were poorer for limbs with tissue loss, except for limb salvage and survival.

Conclusions:

  • Crural angioplasty has limited technical success and durability compared to bypass surgery.
  • Limb salvage rates for crural angioplasty are equivalent to bypass surgery, offering acceptable clinical benefit.
  • Further research is needed to define the optimal role of infrapopliteal angioplasty.
Abstract

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