Background: Infrainguinal angioplasty provides a minimally invasive alternative to bypass surgery in patients with severe limb ischemia in whom surgery involves a high risk. This study aimed to evaluate early patency, limb salvage effect, and initial technical success rates in patients who underwent infrainguinal angioplasty.Patients and Methods: A total of 29 patients (37 limbs) who presented with severe claudication, rest pain, ulcer, gangrene, or a combination of these conditions were treated with infrainguinal angioplasty between February 2005 and September 2006. Angioplasty was performed using appropriately sized balloons or stents, or both. Intraluminal self expanding stents were used in cases of the superficial femoral artery and were not used in the infrapopliteal, tibial, and peroneal arteries.Results: The primary success rates were 100% for superficial femoral artery stenting and infrapopliteal artery balloon angioplasty. The 3-month primary patency rate, primary assisted patency rate, limb salvage rate, and survival rate were 94%, 100%, 96% and 100% for superficial femoral artery stenting, and 89%, 89%, 100% and 86% for infrapopliteal artery balloon angioplasty as estimated by Kaplan-Meier analysis.Conclusions: Infrainguinal angioplasty is a feasible primary treatment of critical limb ischemia in high-risk patients, providing excellent technical success and acceptable patency and limb salvage rates, comparable with surgical bypass surgery.

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A 78-year-old man was referred with rupture of an abdominal aortic aneurysm. He had undergone a bifurcated stent graft implantation for the abdominal aortic aneurysm 5 years previously because of respiratory insufficiency resulting from old tuberculosis and right thoracoplasty. Although a type I endoleak from the proximal portion had been detected, additional treatment was not indicated because of his poor general condition. He suddenly complained of strong back pain, and emergency computed tomography revealed the abdominal aortic aneurysm and a massive hematoma in the retroperitoneal space. Emergency surgery was performed under a diagnosis of ruptured abdominal aortic aneurysm. He fell into shock soon after the initiation of general anesthesia, and prompt laparotomy was followed by cardiopulmonary resuscitation. The systemic arterial pressure increased to 80 mmHg after cross clamping just distal to the renal artery. The previous stent was extracted and graft replacement was successfully carried out. Although his respiratory insufficiency necessitated temporary tracheotomy, he survived without a major disability and returned home 51 days after the operation. Stent grafting has been widely applied especially for poor risk patient. Surgical treatment or additional stent implantation are indicated if an endoleak is detected.

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