Limb salvage following below-the-ankle angioplasty in critical limb ischemia

Abstract

Aim: The aim was to report limb salvage following below-the-ankle (BTA) angioplasty as an adjunct to proximal angioplasty in patients with critical limb ischemia (CLI). Methods: We performed a retrospective analysis of CLI patients who underwent BTA angioplasty as an adjunct to proximal angioplasty between 2013 and 2018 and followed for 6 months. Patient demographics and outcomes were recorded. Outcomes were determined by major amputation (primary outcome), wound healing, and mortality (secondary outcome). Results: Between 2013 and 2018, 59 BTA angioplasties were performed in 52 patients. Patients were divided into two groups based on the results of BTA angioplasty. Successful BTA angioplasty was accessed using post angioplasty angiogram showing a complete plantar arch and improved TcPO2 measurements (preoperative and postoperative). Group 1 (41) includes patients with successful BTA angioplasty and Group 2 (11) includes patients with unsuccessful BTA angioplasty. Patients were followed up for 6 months. Demographics and comorbidities did not influence outcomes in both groups. At the end of 6 months, wound healing, major amputation, and mortality were 92%, 4%, and 4%, respectively, in Group 1 and 9%, 90%, and 54%, respectively, in Group 2. Successful BTA angioplasty has a significant role in preventing major amputation, improved wound healing, and decreased mortality (P < 0.001 [significant]). Conclusions: BTA angioplasty for CLI is technically safe and feasible with satisfactory results for limb salvage.

Keywords

• below-the-ankle angioplasty
• critical limb ischemia
• major amputation