Clinical Efficacy of Successful Angioplasty in Critical Ischemia - A Cohort Study.
ABSTRACT to evaluate the impact of the initial result of percutaneous angioplasty (PA), objectively assessed with duplex-ultrasound, in the three-years clinical outcome.
thirty-nine patients with atherosclerotic disease successfully treated by PA were included (40 limbs). All patients had critical ischemia with rest pain and ischemic ulcers due to infrainguinal obstructions alone. The patients were submitted to duplex-ultrasound examination on the day before and on the first or second day after the procedure. Peak systolic velocities (PSV) was recorded in the anterior tibial, posterior tibial and fibular arteries at the level of distal third of the leg. All patients were followed for 3 years. Comparison between good and bad groups were based on perioperative VPS gradient (GPSV) of the mean of the VPS in the 3 arteries. After 3-years good result were defined as good when the patient had no pain and complete healing of a previous ulcer or minor amputations.
Mean age was 68,5 ± 8,1 years-old with no difference in demographic characteristics (p>0,05). In 26 cases the long-term result was good. Healing time ranged from 4 to 130 weeks (median 26.5). Bad long-term results were observed in 12 cases. Two lesions had persisted unhealed despite patent angioplasty. In 10 cases a second procedure was carried out (redo angioplasty in 6 and bypass in 4). TASCII A/B registered better clinical success then TASCII C/D (p<0,05) at 1-year follow-up but not at 3-years (p=0,36). Two-year limb salvage was 92,5% ± 4,2%. Primary patency was 52,5% ± 9,5% in 3-years. GVPS was 21,9 cm/s in good group and 24,7cm/s in bad group (p>0,05). The quality of the initial result, as measured by GPSV, was not associated with a good or bad long-term success (p>0,05).
once the procedure was successfully performed, the degree of increase in flow is not related to the long-term durability and ulcer healing. Descriptors: Angioplasty; Lower extremity; Ultrasonography Doppler; Surveillance; Postoperative period; Atherosclerosis; Leg ulcer; Wound healing.