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Hemodynamic assessment of transluminal angioplasty for lower extremity ischemia
Insights
Percutaneous transluminal angioplasty (PTA) effectively treats iliac artery blockages causing leg ischemia. However, femoropopliteal PTA shows less success and requires further study for optimal patient outcomes.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Lower extremity ischemia significantly impacts patient quality of life.
- Percutaneous transluminal angioplasty (PTA) offers a minimally invasive treatment option.
- Indications for PTA include intermittent claudication, rest pain, and ischemic ulceration.
Purpose of the Study:
- To analyze the effectiveness of PTA in treating lower extremity ischemia.
- To evaluate technical success and hemodynamic outcomes of PTA in iliac and femoropopliteal lesions.
- To determine the long-term durability of PTA interventions.
Main Methods:
- Retrospective analysis of 56 PTA procedures in 51 patients with ischemic lower extremities.
- Assessment of technical success rates for iliac and femoropopliteal lesions.
- Monitoring of hemodynamic parameters (ankle-brachial index, thigh index) and symptomatic improvement post-procedure.
Main Results:
- High technical success (94.1%) and sustained hemodynamic improvement in iliac segment lesions.
- Lower technical success (73.8%) in femoropopliteal lesions, with 44.4% losing hemodynamic benefit during follow-up.
- Symptomatic improvement was observed in all technically successful cases.
Conclusions:
- PTA is a valuable treatment for selected short-segment iliac lesions causing lower extremity ischemia.
- Balloon dilation of femoropopliteal lesions is less successful and warrants further investigation.
- Close monitoring of hemodynamic, symptomatic, and angiographic results is crucial for defining PTA's role in treating lower extremity ischemia.
Abstract:
The results of percutaneous transluminal angioplasty (PTA) for 56 ischemic lower extremities in 51 patients were analyzed. Indications for balloon catheter dilatation were intermittent claudication in 46 limbs (82.1%), rest pain in five (8.9%), and ischemic ulceration in five (8.9%). Balloon dialation was technically successful in 16 of 17 iliac segment lesions (94.1%) with symptomatic improvement in each instance. Nine of the 16 limbs were hemodynamically improved with a significant increase (less than 0.15) in ankle systolic pressure index. Four additional limbs had improvement in the thigh index. The remaining three limbs were hemodynamically unimproved. During average follow-up of 7.1 months, the 13 initially improved limbs remained hemodynamically improved. Thirty-one of 42 femoropopliteal dilatations (73.8%) were technically successful, with uniform symptomatic improvement. Of these 31 limbs, 26 had a significant initial increase in ankle index, one had improvement in distal thigh index only, and the remaining four limbs were hemodynamically unimproved. During mean follow-up of 8.4 months in the 27 limbs that initially were improved after femoropopliteal dilation, the pressure index returned to the pre-PTA level in 12 instances (44.4%). These results indicate that PTA is useful in selected short-segment iliac lesions. Balloon dilation of femoropopliteal lesions was less successful and its application requires further evaluation. This study demonstrates the need for close monitoring of the objective hemodynamic response, as well as symptomatic and angiographic results, in establishing the proper role of PTA in the treatment of lower extremity ischemia.