Infrapopliteal angioplasties for limb salvage in diabetic patients: Does the clinical outcome justify its use?

PURPOSE: To analyze the results of infrapopliteal percutaneous transluminal angioplasty (PTA) as a primary treatment modality in diabetic patients with non- healing ulcers or gangrene. MATERIALS AND METHODS: We retrospectively studied 35 angioplasties, performed as the first line of treatment to salvage diabetic feet. The patients were followed up for 12 months. RESULTS: Grade 1 and 2 ulcers were seen in only 20% of patients (5.71 and 14.28%, respectively); 37.14% of patients had grade 3 ulcer, and 42.8% were in the gangrene stage (grade 4 - 34.2% and grade 5 - 8.5%). A total of 77 lesions in 46 arteries (including six popliteal and suprapopliteal lesions) were dilated in 35 limbs. Of the 71 infrapopliteal lesions, 86% of lesions were classified as group C or D (group A - 9.3%, group B - 4.65%, group C - 37.2%, and group D - 48.83%). Overall technical success rate was 84.7%. The vascular complication rate was 26% (12 arteries out of 46). Clinical success was achieved in 29.1% of cases at the end of 6 months and 58.6% at the end of one year. Limb salvage rates were 79.4% at the end of 6 months and 75.8% at the end of one year. CONCLUSIONS: A high technical success rate can be achieved even in situations traditionally considered unfavorable for angioplasty. Infrapopliteal angioplasty can produce limb salvage rates comparable to bypass surgery in diabetic patients with extensive disease.