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Limb salvage in high-risk patients with multisegmental disease
Insights
Percutaneous iliac angioplasty combined with distal bypass offers a valuable limb salvage strategy for high-risk patients. This approach demonstrated significant pressure improvements and high limb salvage rates, supporting its use in critical limb ischemia cases.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- High-risk patients with critical limb ischemia often face limited treatment options.
- Iliac angioplasty and distal bypass are established revascularization techniques.
- The combined strategy's efficacy in high-risk limb salvage remains an area of investigation.
Purpose of the Study:
- To evaluate the effectiveness of percutaneous iliac angioplasty preceding distal bypass in high-risk patients.
- To assess limb salvage rates and hemodynamic improvements associated with this combined intervention.
Main Methods:
- Retrospective review of 113 iliac angioplasty procedures.
- Identification of 10 high-risk patients who underwent combined iliac angioplasty and distal bypass.
- Life-table analysis for limb salvage rates and ankle-brachial index (ABI) measurements.
Main Results:
- No interventional deaths or complications occurred.
- Significant improvement in ABI from 0.28 ± 0.2 to 0.92 ± 0.08 (p < 0.0005).
- Limb salvage rates were 90% at 1 month, 80% at 6 months, and 70% at 1-3 years.
Conclusions:
- Percutaneous iliac angioplasty followed by distal bypass is a viable limb salvage option for high-risk patients.
- The combined intervention leads to significant hemodynamic improvement and durable limb salvage.
- Despite high overall mortality in this high-risk cohort, the angioplasty/bypass strategy offers a valuable treatment pathway.
Abstract:
Is percutaneous iliac angioplasty before distal bypass a logical limb salvage option in a high-risk patient? A retrospective review of 113 iliac angioplasty procedures identified 10 patients in this situation. Angioplasty preceded femoropopliteal bypass (five), femorotibial bypass (three) and, in one case each, femorofemoral bypass or profundoplasty. There were no interventional deaths or complications. Ankle/brachial pressure index improvement followed intervention: 0.28 + 0.2 vs. 0.92 + 0.08, (p less than 0.0005). Limb salvage was 90% at one month, 80% at six months and 70% at one to three years by Life-Table analysis. Two patients with a patent bypass lost limbs from uncontrolled infection within two months. One patient required an amputation 311 days after the only failure of angioplasty and distal bypass. During this study period, 56% of the patients died. This review supports an angioplasty/bypass combined intervention as a valuable treatment option in high-risk patients facing limb loss.