Clinical Implications of Additional Pedal Artery Angioplasty in Critical Limb Ischemia Patients With Infrapopliteal and Pedal Artery Disease

Tatsuya Nakama, MD, Nozomi Watanabe, MD, PhD1, Toshiyuki Kimura, MD1, Kenji Ogata, MD1, Shun Nishino, MD1, Makoto Furugen, MD, PhD1, Hiroshi Koiwaya, MD, PhD, Koji Furukawa, MD, Eisaku Nakamura, MD, PhD, Mitsuhiro Yano, MD, PhD, Takehiro Daian, MD, PhD, Nehiro Kuriyama, MD, PhD, and Yoshisato Shibata, MD

Purpose: To evaluate the clinical implications of additional pedal artery angioplasty (PAA) for patients with critical limb ischemia (CLI).

Methods: Twenty-nine patients (mean age 77.8±8.6 years; 21 men) with CLI (32 limbs) presenting with de novo infrapopliteal and pedal artery (Kawarada type 2/3) disease were reviewed. The need for PAA was based on the existence of sufficient wound blush (WB) around the target wounds after conventional above-the-ankle revascularization. Fourteen patients with insufficient WB in 14 limbs received additional PAA, while 15 patients with sufficient WB in 18 limbs did not. The groups were compared for overall survival, limb salvage, and amputation-free survival within 1 year after the procedure. The wound healing rate, time to wound healing, and freedom from reintervention rate were also evaluated.

Result: The success rate of additional PAA was 93% (13/14). All limbs with successful PAA achieved sufficient WB (13/13). Despite insufficient WB before the additional PAA, overall survival (86% vs 73%, p=0.350), limb salvage (93% vs 83%, p=0.400), amputation-free survival (79% vs 53%, p=0.102), and freedom from reintervention (64% vs 73%, p=0.668) rates were similar in both groups. Furthermore, the wound healing rate (93% vs 60%, p=0.05) was higher and time to wound healing (86.0±18.7 vs 152.0±60.2 days, p=0.05) was shorter in the patients who received PAA.

Conclusion: Additional PAA might improve the WB and clinical outcomes (especially speed and extent of wound healing) in patients with CLI attributed to infrapopliteal and pedal artery disease.

Keywords: angiosome; balloon angioplasty; below-the-ankle intervention; critical limb ischemia; infrapopliteal disease; limb salvage; occlusion; pedal artery; percutaneous transluminal angioplasty; peripheral artery disease; wound healing.

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