Mathew Cherian MD, Abstract Co-Author: Nothing to Disclose

Tejas Mohan Kalyanpur DMRD, Presenter: Nothing to Disclose

Ruhi Karwal, Abstract Co-Author: Nothing to Disclose

Pankaj Mehta MD, Abstract Co-Author: Nothing to Disclose

Sandeep Subhash Hedgire MBBS, Abstract Co-Author: Nothing to Disclose

Kaustubh S Narsinghpura MBBS, DMRD, Abstract Co-Author: Nothing to Disclose

To study the efficacy & safety of below knee angioplasty as limb salvage procedure in category 4 patients.

All patients with Peripheral Vascular Disease were categorized into fontaine grading. Pre procedure ABI was measured & DSA performed. Only hemodynamically significant stenosis more than 50% were treated. 0.18 wire, V-18 was used to cross the lesions & balloon of appropriate size used to dilate affected segment. Success graded depending on shift of ABI 24 hours later. Patients were followed up for mean period of one year. If patients underwent an amputation its level & wound healing of post operative stump was noted.

120 out of 224 patients underwent PTA of below knee vessels. 97% belonged to category 4. Of 764 below knee affected segments 164 were amenable to angioplasty. Technical success was achieved in all patients. 41% of lesions treated were in popliteal artery, 12.1% in TPT, 2% in peroneal, 14.6% in PTA & 29.2% lesions in ATA. Of the 164 arterial segments treated in 120 patients, 30% also underwent proximal vessel angioplasty 8 of which were 3rd order lesions. Majority of lesions treated were single focal stenosis in 46% followed by multifocal stenosis in 37%. 8% of segments were stenosis measuring 1–4 cm &10% constituted occlusions greater than 2 cm. No major procedure related complications occurred. 4 patients developed groin hematoma that resolved without any intervention. Post 24 hrs ABI showed a grade 2  rise in 56% and grade 4 rise in 44% of limbs. All patients presenting with rest pain & intermittent claudication had complete symptomatic relief after procedure. 12 patients expired during course of study due to non procedure related systemic conditions. Of the 80 patients with ulcer, initial healing without amputation was achieved in 55% & with amputations in all 36 patients. Among  patients that underwent amputations 77 % were toe amputations. Only 8 cases underwent significant amputation. All patients had normal course of wound healing postop. Limb salvage rate at end of one year was 92.8%.

Short term results of infrapopliteal angioplasty are excellent and can be considered as the first line of therapy as a limb salvage procedure in treatment of patients even with complex category 4 arterial disease.

PTA can achieve comparable results in terms of limb salvage without the risk of operative mortality and morbidity even in category 4 patients

Cherian, M, Kalyanpur, T, Karwal, R, Mehta, P, Hedgire, S, Narsinghpura, K, Efficacy of Below Knee Angioplasty as a Limb Salvage Procedure.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8015793.html