Pedal Artery Angioplasty: Beneficial in Critical Limb Ischemia

Courtesy of Dr. Carlos Fava.

Pedal Artery Angioplasty: Beneficial in Critical Limb Ischemia

Delaying or failing to heal trophic wounds in critical limb ischemia (CLI) changes quality of life, delays rehabilitation and is associated to infections and amputation.

 

Pedal artery revascularization with angioplasty would speed up recovery and improve CLI wound healing.

 

The study analyzed 257 patients with de novo infrapopliteal lesions receiving PCI for CLI. 140 of these patients (54.5%) received pedal artery angioplasty (PAA).

 

Mean age was 73, all patients were in Rutherford class 5 or 6, and one third of patients presented >3 mg/dl creatinine. There were no differences in type, location depth or infection of trophic wounds.

 

Angiosome direct revascularization was successful in 60.3% of the population. In PAA patients, ankle brachial index (0.88 vs. 0.81; p=0.004) and skin perfusion pressure was higher (49.3 mmHg vs. 41.9 mmHg; p=0.02).

 

At one year follow up, limb salvage was 88.5% and amputation free survival rate was 73.5%. Wound resolution was 49.5%. In the moderate risk group, pedal artery revascularization saw better resolution of trophic wounds and better time to wound healing (59.3% vs. 38.1%; p=0.003 y 211 vs. 365 days; p=0.008).

 

Independent predictors of delayed healing were:

  • non ambulatory status
  • wound depth (UT ≥2)
  • the need for hemodialysis

 

Conclusion

Patients receiving pedal artery angioplasty showed higher trophic wound healing and better time to healing. As regards wound healing, this aggressive strategy could become a salvage procedure for patients with CLI and pedal artery disease.

 

Editorial Comment

Critical Limb Ischemia is on the rise, and in this analysis, a more aggressive angioplasty procedure showed benefits, especially in high risk groups.

 

It is important to have programs for this group of patients and to familiarize with wound classification, depth and infection presence (UT and WIFI classifications) to be able to better assess strategies.

 

Courtesy of Dr. Carlos Fava. Favaloro Foundation, Buenos Aires, Argentina.

 

Original Title: Clinical Outcome of Pedal Artery Angioplasty for Patients with Ischemic Wounds

Results from the Multicenter RENDEZVOUZ Registry.

Reference: Tatsuya Nakama, et al. J Am Coll Cardiol Intv 2017;10:79-90.


Suscríbase a nuestro newsletter semanal

Reciba resúmenes con los últimos artículos científicos

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

TCT 2024 | SIRONA: Randomized Study Comparing Sirolimus-Coated vs Paclitaxel-Coated Balloon Angioplasty in Femoropopliteal Disease

This prospective, randomized, multicenter, investigator-initiated non-inferiority study compared the use of sirolimus-coated balloon (MagicTouch) vs paclitaxel-coated balloon in endovascular treatment.  The primary objective was to...

TCT 2024 | PEERLESS: Mechanical Thrombectomy with FlowTriever vs Catheter-Directed Thrombolysis in Intermediate Risk PTE

Pulmonary embolism (PE) continues to be the third cause of cardiovascular mortality. The current clinical guidelines recommend anticoagulation in intermediate risk patients presenting right...

Atherosclerotic Renal Artery Stenosis: To Revascularize or Not

At long term, atherosclerotic renal artery stenosis (RAS) can lead to hypertension, chronic kidney disease, and cardiac failure. Historically, these patients have been referred...

Endovascular Management of Chronic TEPH: Is Coronary Management Extrapolatable in This Scenario?

Chronic thromboembolic pulmonary hypertension (CTEPH) is a condition that causes significant functional limitation. Its surgical treatment, known as pulmonary endarterectomy (PEA), has improved the...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...