Percutaneous interventions below the knee in patients with critical limb ischemia using drug eluting stents

J Cardiovasc Surg (Torino). 2010 Apr;51(2):183-91.

Abstract

Aim: Midterm technical and clinical evaluation of stent angioplasty with drug-eluting stents in infrapopliteal lesions in patients with critical limb ischemia (CLI).

Methods: Percutaneous stent angioplasty was performed in 128 limbs in 114 patients presenting with 320 vascular lesions. Lesions with up to 6 cm in length and at least one patent vessel below the obstruction were treated; 341 drug-eluting Cypher(R) stents (diameter of 2.5-3.5 mm; length of 18-33 mm) were implanted. Follow-up examinations were performed up to 18 months postinterventionally using clinical examination, ankle-brachial index (ABI) calculation, and color coded Duplex sonography. Patency rates were calculated on the basis of the Kaplan-Meier life-table analysis.

Results: Technical success was achieved in 99.06%. Minor complications (hematoma, distal emboli, and vessel dissection) were documented in 8.77% of the patients. The 6, 12, and 18 months primary patency rate as controlled by Duplex sonography was 89.8, 84.2 and 83.3%, respectively; 77.6% of the lesions healed postinterventionally. The cumulative limb salvage rate was 95.6%.

Conclusion: Drug-eluting stent (DES) angioplasty in infrapopliteal arteries is a safe and effective technique for the treatment of patients with CLI. The use of a DES results in favorable technical and clinical outcome in the midterm follow-up.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon / adverse effects
  • Angioplasty, Balloon / instrumentation*
  • Ankle Brachial Index
  • Arterial Occlusive Diseases / complications
  • Arterial Occlusive Diseases / diagnosis
  • Arterial Occlusive Diseases / physiopathology
  • Arterial Occlusive Diseases / therapy*
  • Cardiovascular Agents / administration & dosage*
  • Critical Illness
  • Drug-Eluting Stents*
  • Female
  • Germany
  • Humans
  • Ischemia / diagnosis
  • Ischemia / etiology
  • Ischemia / physiopathology
  • Ischemia / therapy*
  • Kaplan-Meier Estimate
  • Limb Salvage
  • Lower Extremity / blood supply*
  • Male
  • Middle Aged
  • Prospective Studies
  • Severity of Illness Index
  • Sirolimus / administration & dosage*
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Doppler, Color
  • Vascular Patency

Substances

  • Cardiovascular Agents
  • Sirolimus