Percutaneous transluminal angioplasty in patients with ischemic tissue necrosis is worthwhile

Purpose: Ischemic tissue necrosis is usually associated with long or sequen tial arterial obstructions. As a result, the role of percutaneous translumi nal angioplasty (PTA), which addresses only short lesions, in patients pres enting with trophic changes remains questionable. The purpose of this study was to evaluate the effectiveness of PTA in diabetic and non-diabetic pati ents presenting with grade 4 Fontaine's classification. Method: Between January 1992 and December 1997, 1352 patients with aorto-il iac and/or infrainguinal occlusive diseases were admitted to our institutio n, Three hundred and ten patients who presented with distal gangrene (95.5% ) or ischemic ulcers (4.5%) were identified. The patients consisted of 117 diabetics and 193 non-diabetics. PTA alone was performed in 26 diabetics (g roup 1) and in 30 non-diabetics (group 2), Their charts were retrospectivel y reviewed and the patients were recalled for clinical examination and non- invasive monitoring. Results: Follow-up was available for ail patients and ranged from 1 to 4 ye ars. The survival rate was significantly higher in diabetic patients than i n non-diabetic patients (96% vs 77% at 1 year: p < 0.05 and 91% vs 66% at 3 years: p < 0.05). In group 1, the primary cumulative patency rate at 1 and 3 years was 76%. In group 2, the primary cumulative patency rate at 1 and 3 years were 85% and 80%, respectively. Three patients in group 1 required a redo PTA at 4 months, resulting in an assisted primary patency rate at 1 and 3 years of 88%, In contrast, no patients in group 2 required additional PTA. In group 1,the limb salvage rate at 1 and 3 years was 84%; and in gro up 2, 80% and 75%, respectively. Conclusion: The results of PTA in both groups were encouraging, Dilation of one or two short stenoses, despite multiple distal lesions, may improve di stal flow sufficiently to promote wound healing. Thus, this procedure may b e recommended in selected patients suffering from ischemic tissue loss. How ever, during the first 6 months following PTA, diabetic patients should be followed carefully with Duplex as they are prone to early restenosis. (C) 2 001 The international Society for Cardiovascular Surgery. Published by Else vier Science Ltd. All rights reserved.