Subintimal Angioplasty for Below-the-Ankle Arterial Occlusions in Diabetic PatientsWith Chronic Critical Limb IschemiaYue-Qi Zhu； Jun-Gong Z
Subintimal Angioplasty for Below-the-Ankle Arterial Occlusions in Diabetic Patients
With Chronic Critical Limb Ischemia
Yue-Qi Zhu； Jun-Gong Zhao；Fang Liu； Jian-Bo Wang； Ying-Sheng Cheng；
Ming-Hua Li；Jue Wang；Jie Li
Departments of Radiology and Endocrinology, The Sixth Affiliated People’s
Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
Purpose: To assess the feasibility and efficacy of subintimal angioplasty (SA) in
the treatment of below-the-ankle arterial occlusion in diabetic patients with chronic
critical limb ischemia (CLI).
Methods: SA was applied in 37 diabetic patients (24 men; mean age 70.9±8.5 years,
range(52–88) with chronic CLI and occlusive disease of the dorsalis pedis artery
(DPA) and/or plantar artery (PA) but were poor candidates for intraluminal
angioplasty or bypass surgery. Tissue loss was present in 31 (54.4%) of 57 afflicted
limbs, and rest pain was reported in 51 (89.5%) limbs. SA was performed to create
continuous arterial flow to the foot for limb salvage. The clinical symptoms, DPA or
PA pulse volume scores, and ankle brachial index (ABI) were compared before and
after SA. Wound healing, amputation, and restenosis of target vessels were also
evaluated at follow-up. Kaplan-Meier curves wereconstructed to evaluate limb salvage,
survival, and freedom from amputation.
Results: Below-the-ankle SA was performed successfully in 55 (83.3%) of 66 arteries
in 57 limbs. Median pulse volume scores and ABIs were 0.33±.055 and 0.31±.019
before SA and 2.04±1.05 and 0.80±0.14 after SA, respectively (p<0.0001 for both).
The 30-day mortality was 2.7%. Median follow-up was 9.1±6.1 months (range 1–18).
Majorcomplications occurred in 1 (2.7%) patient and minor complications in 3 (8.1%).
Twelve months after SA, Kaplan-Meier analysis showed that the limb salvage rate
was 94.6%, the freedom from amputation was 89.2%, and the survival rate
Conclusion: SA of the dorsalis pedis artery and/or plantar artery is a useful
technique for lower limb salvage in diabetic patients with chronic CLI who are not
candidates for bypass surgery.
J Endovasc Ther. 2009;16:604–612