Have an account? Please log in.
Text size: Small font Default font Larger font
.
Radiology Daily
Radiology Daily PracticalReviews.com Radiology Daily

Infrapopliteal Stenting A Good Way to Treat Failed Angioplasty

August 12, 2009
Written by: , Filed in: Cardiac Imaging
  • Comments
.

Arterial stent placement below the knee in cases of technically unsuccessful percutaneous transluminal angioplasty (PTA) procedures provides vessel patency rates similar to those of successful PTA.

Background
For chronic critical limb ischemia, percutaneous transluminal angioplasty (PTA) below the knee is being used routinely for limb salvage. Angioplasty and stent placement is well described in the suprapopliteal region of the vascular tree. In the authors’ institution, half of the technically unsuccessful limb salvage procedures were unsuccessful angioplasties.

Objective
To determine if stent placement in infrapopliteal arteries successfully treat failed angioplasty and to determine the patency after 1 year and the stent’s effectiveness in limb salvage.

Design
Prospective study.

Methods
The patients were eligible for the study if they had chronic critical limb ischemia and new onset stenoses .50% or segmental occlusion in the anterior tibial (AT) or posterior tibial (PT) arteries, because they were easier to evaluate via palpation or ultrasound. The study limbs were assigned to 1 of 3 groups:
(1) vessels with suboptimal PTA results assigned to stent placement (23 stents in 16 patients);
(2) vessels with a good outcome of PTA (n=54);
(3) vessels with no PTA needed because the stenosis was <50% (controls, n=24). Suboptimal angioplasty was defined as a residual stenosis of >30% and was treated with Xpert® stents, 4-5 mm in diameter (1-mm larger than the native vessel) and 4-6 cm in length. Follow-up with Doppler and palpation occurred during the first week and at 3, 6, and 12 months.

Cardiac CTA: What You Need to Know
 
 University of California San Francisco, Department of Radiology
 Course Director: Gautham P. Reddy, MD, MPH

 
  Coronary artery disease is the leading cause of morbidity and mortality in industrialized countries. With the advent of 64-detector CT scanners, CT has become an essential tool for evaluation of the heart and great vessels, and is a promising technique for assessment of the coronary arteries.
 
  Click here to read more or order:
  Cardiac CTA: What You Need to Know

Results
Stent placement was successful in all patients, with a palpable pulse felt distally after the procedure. The 1-year patency rate of the arteries was 82% for the simple PTA, 78% for the stented arteries, and 69% for the arteries upon which no intervention was done. According the Kaplan-Meier analysis, there was no statistical difference between the stent group and the other groups.

Reviewer’s Comments
In chronic critical limb ischemia, the method of choice is PTA for salvage of functional limbs. The fact still remains that patients who are treated conservatively have a risk of death double that of patients who are treated aggressively. Therefore, patent vessels may prolong patient survival. A certain number of angioplasties will yield unsatisfactory results. If stenting can make these procedures successful, the overall limb salvage rate will increase. This study has shown that the 1-year patency of the stented vessels is at least as high as angioplasty alone.

Author: Sharon Gonzales, MD
Reference:
Peregrin JH, Å mírová S, et al. Self-Expandable Stent Placement in Infrapopliteal Arteries After Unsuccessful Angioplasty Failure: One-Year Follow-Up. Cardiovasc Intervent Radiol; 2008;31 (September-October): 860-864

Cardiac CTA: What You Need to Know
 
 University of California San Francisco, Department of Radiology
 Course Director: Gautham P. Reddy, MD, MPH

 
  Coronary artery disease is the leading cause of morbidity and mortality in industrialized countries. With the advent of 64-detector CT scanners, CT has become an essential tool for evaluation of the heart and great vessels, and is a promising technique for assessment of the coronary arteries.
 
  Click here to read more or order:
  Cardiac CTA: What You Need to Know
.
  • Comments
.

Would you like to keep current with radiological news and information?

Post Your Comments and Responses

Comments are closed.