Below The Knee PTA In Treatment Of Diabetic Foot

Objective: Aimed to evaluate the long-term results of successful PTA fortechnical analysis in diabetic foot.Methods: Retrospective analysis from February2008to December2011,Fontaine stage III~IV of diabetic foot ulcers with93cases（106limbs）, preoperativeassessment of ischemia stage, measurement of ankle brachial index and areaof ulcer, the vascular ultrasound or CTA clear vascular lesions. Take theanterograde or retrograde puncture of the femoral artery, clearly the lesions’location, nature and length. The guide wire cooperated with the catheteracross the occluded segment to the distal vessel cavity, and confirmedreturn to the true lumen. According to the lesions selected suitable modelsof Deep、 Bantam or Reekross18balloon dilatation stenosis and occlusionarteries below the knee. Follow-up examinations were performed up to1-month,6-month,1-year,2-year and3-year postinterventional, using clinicalexamination, color-coded duplex sonography, CTA and DSA, observed success rateof surgery, the ankle/brachial index (ABI), ulcer healing, limb salvage rate andreconstruction patency rate.Results: In this group of cases involved the anterior tibial artery of theaffected limb for81cases, the posterior tibial artery of the affected limb for97cases, and the peroneal artery for72cases. Also the anterior tibial arteryand the posterior tibial artery involvement limb for78cases, anterior tibialartery and peroneal artery simultaneously involved limbs in66cases,posterior tibial and peroneal artery simultaneously involved limbs for60cases. In addition, three branches of the artery all involved limbs were81cases,32limbs with superficial femoral artery lesions. Below the knee,three diffuse occlusion cases, by transluminal angioplasty, reconstructed three vessels successfully in5cases (6.1%), reconstructed two branchessuccessfully in18cases (22.2%), and reconstructed one branch successfullyin58cases (71.6%). In addition, two lesions, reconstructed two branches in4cases (25%), reconstructed a branch in8cases (50%). In103limbs,successful reconstructing of one branch artery at least, and the residualstenosis is less than30%, the technical success rate is97.8%. Except2cases ofknee arterial dissection, the remaining patients are with no severecomplications. The median ankle-brachial index (ABI) increased from0.46±0.15to0.89±0.20after intervention. The clinical symptoms of all patients improved aftersuccessful PTA. In60patients with ulcer and gangrene of diabetic footpatients,55patients’ ulcer healed, the ulcer healing rate was91.7%(55/60),and the average healing time is6-months (1-12). The1-year,2-year and3-yearlimb salvage rate was98.9%,97.1%and96.3%, respectively. And1-month,6-month,1-year,2-year and3-year primary patency rate was93.3%,78.1%,54.9%,34%and4.5%, respectively.Conclusion: Besides high success rate, limb salvage rate, PTA is safe, effectiveand can be highly repetitive. PTA can be performed as the first choice in treatment ofDiabetic Foot.