Complex endovascular treatment for critical limb ischemia in poor surgical candidates

A pilot study

Bruce H. Gray, John R. Laird, Gary M. Ansel, John W. Shuck

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Purpose: To evaluate the effectiveness of complex endovascular treatment for limb salvage in patients with critical limb ischemia. Methods: In a prospective study, 23 patients (13 men; mean age 70 ± 11 years, range 44-87) with ischemic ulceration or gangrene of 25 lower limbs were enrolled at 4 sites to evaluate treatment with excimer laser recanalization followed by balloon angioplasty with optional stenting in the superficial femoral, popliteal, and/or tibial arteries. Results: Multiple lesions (mean 3.1, range 1-8) were treated in most cases. Reduction of stenosis/occlusion to <50% was achieved in 22 (88%) limbs. Individual cases of vessel perforation, inability to cross the lesion, and excessive residual stenosis accounted for the 3 failures. Over a 6-month period, 4 patients died of cardiac comorbidity and 1 was lost to follow-up. Adverse events included 4 minor and 2 below-knee amputations, 4 secondary angioplasties, and 4 femorodistal bypasses. The mean wound area reduction was 70% at 3 months, increasing to 89% at 6 months. According to life table analysis, the limb salvage rate was 90% with bypass and 69% without in the successfully treated patients (corresponding intention-to-treat rates were 79% and 61%). Conclusions: Complex endovascular treatment combining laser debulking and angioplasty/stenting offers an alternative for patients with critical limb ischemia who lack good surgical options.

Original languageEnglish (US)
Pages (from-to)599-604
Number of pages6
JournalJournal of Endovascular Therapy
Volume9
Issue number5
DOIs
StatePublished - Oct 2002
Externally publishedYes

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Ischemia
Extremities
Limb Salvage
Pathologic Constriction
Laser Angioplasty
Tibial Arteries
Therapeutics
Popliteal Artery
Excimer Lasers
Life Tables
Gangrene
Balloon Angioplasty
Lost to Follow-Up
Femoral Artery
Amputation
Angioplasty
Comorbidity
Lower Extremity
Knee
Prospective Studies

Keywords

  • Balloon angioplasty
  • Excimer laser
  • Occlusion
  • Stent
  • Superficial femoral artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Complex endovascular treatment for critical limb ischemia in poor surgical candidates : A pilot study. / Gray, Bruce H.; Laird, John R.; Ansel, Gary M.; Shuck, John W.

In: Journal of Endovascular Therapy, Vol. 9, No. 5, 10.2002, p. 599-604.

Research output: Contribution to journalArticle

Gray, Bruce H. ; Laird, John R. ; Ansel, Gary M. ; Shuck, John W. / Complex endovascular treatment for critical limb ischemia in poor surgical candidates : A pilot study. In: Journal of Endovascular Therapy. 2002 ; Vol. 9, No. 5. pp. 599-604.
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