Nephrologists can offer patients a nonsurgical way to treat peripheral arterial disease.
SEATTLE—Percutaneous transluminal angioplasty (PTA) safely treats infragenicular arterial disease and helps to preserve limbs, according to a study presented here at the Society of Interventional Radiology annual meeting.
“This is a way of saving limbs,” said lead investigator Nael Saad, MD, who noted that these patients often are under the care of nephrologists. “Many of these patients have end-stage disease where they have ulcerations and gangrene in their leg,” said Dr. Saad, an interventional radiologist and a fourth-year resident at the University of Rochester Medical Center in Rochester, N.Y. “We can actually offer an endoluminal therapy that is not surgical at all. There is just a little nick in the skin and a Band-Aid. They leave the next day and we help them preserve the function of their limb.”
He and his colleagues studied 57 patients (mean age 73 years). The study group was 66% male and 85% had a history of smoking. Among patients treated, 53% had kidney disease (serum creatinine greater than 1.5 mg/dL), 56% were diabetic, and 91% were hypertensive. PTA was used to treat 96 infragenicular arterial lesions in 59 limbs. The mean follow-up time was eight months (range 0–37 months) and primary assisted patency and limb salvage rates were assessed at 3, 6, 12, and 18 months.
A total of 43 legs were saved from amputation. Twenty-nine patients were alive at the end of the study with intact limbs, 10 were alive with an amputated limb, 14 died with an intact limb, and four patients died with an amputated limb.
PTA opens blockages in 97% of cases, with patency rates of 85% at one year and 77% at two years, the study found. Re-treating blockages kept 92% of the arteries open up to two years.
“The study shows that angioplasty and stenting can restore blood flow through the smallest vessels in the legs and keep them open long-term, saving patients from life-altering amputation,” Dr. Saad said. “Aggressive interventional therapy should be considered in all patients as a first option. In general, the long-term clinical results are comparable to bypass surgery in the leg using a longer, more complex graft, but with a much lower risk of morbidity and mortality.”
Many patients who are candidates for angioplasty and stenting do not get referred because the success rates reported in the literature have been mixed. Improved technologies and refining of techniques, however, have improved success rates. In Dr. Saad’s study population, few complications occurred. One patient needed surgery because of an occluded artery.
“This is one of the first studies of its kind and it is a large number of patients,” Dr. Saad said. “Nephrologists need to know that this is something that can be offered, and it may provide a much better quality of life, even advanced peripheral arterial disease with critical limb ischemia.”