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Primary stent-supported angioplasty for treatment of below-knee critical limb ischemia and severe claudication

Early and one-year outcomes

Columbia-St. Mary's Medical Center, Milwaukee, Wisconsin

View larger version (18K): [in a new window]   Figure 1 Distribution of patients based on success or failure of below-knee stent-supported angioplasty. AMP-CLI = patients with critical limb ischemia (CLI) who subsequently underwent below-knee amputation after multiple failed interventions; PTA-LLC = percutaneous transluminal angioplasty for lifestyle-limiting claudication; TVR = target vessel revascularization.

View larger version (112K): [in a new window]   Figure 2 (A) Sixty-year-old diabetic woman. Note the deep, broad-based nonhealing foot ulcer. Despite five months of conservative therapy, the ankle brachial index was 0.42 with a toe pressure of 25 mm Hg. Before vascular intervention she underwent coronary bypass for left main three-vessel coronary disease. (B) Three months after primary stent-supported intervention, aspirin, and clopidogrel, the ulceration demonstrates complete healing that has been maintained for three years. (C) Pre-intervention angiogram demonstrating complete occlusion of the posterior tibial and peroneal arteries and a long subtotal occlusion (solid arrows), of the anterior tibial artery. (D) Post-intervention angiogram after placement of two balloon-expandable coronary Hepacoat (Cordis) stents. One-month resting ankle brachial index normalized to 0.98.

View larger version (67K): [in a new window]   Figure 3 (A) Pre-intervention angiogram in a 78-year-old man with lifestyle-limiting claudication and resting ankle brachial index (ABI) of 0.41. Note the total occlusion of the distal popliteal artery (A) and absence of any named tibial vessels. (B) Postintervention angiogram with a 4.0 x 32-mm stent placement in the popliteal artery and a 3.5 x 32-mm stent placed in overlapping fashion extending into the posterior tibial artery. One-month ABIs normalized to 1.03 and claudication was relieved.

View larger version (17K): [in a new window]   Figure 4 Box and whisker plot for the entire cohort, depicting the resting ankle brachial index (ABI) before (pre) and after (post) intervention. *p 0.0001 for improvement in ABI from baseline.

View larger version (17K): [in a new window]   Figure 5 Box and whisker plot for patients with critical limb ischemia (CLI), depicting resting ankle brachial index (ABI) before (pre) and after (post) intervention. *p 0.0001 for improvement in ABI from baseline.

View larger version (16K): [in a new window]   Figure 6 Box and whisker plot for patients with severe lifestyle-limiting claudication and jeopardized single-vessel runoff, depicting resting ankle brachial index (ABI) before (pre) and after (post) intervention. *p 0.0001 for improvement in ABI from baseline.

View larger version (17K): [in a new window]   Figure 7 Qualitative improvement in baseline symptoms for the entire cohort. *p 0.0001 for improvement from baseline. There were no significant changes between one month and six months.