[Independent factors related to limb salvage and survival in distal angioplasty for critical ischemia].

INTRODUCTION: Infragenicular multisegmentar atherosclerotic disease is prevalent in diabetic and chronic renal failure (CRF) patients and associated with critical ischemia ulcera related. Distal angioplasty revascularization is an option allowing wound healing and improvement of life quality. Objectives Identification and impact determination of independent factors related to limb salvage and mortality in patients submitted to distal angioplasty.

METHODS: Between January 2010 and December 2012, 31 balloon angioplasties were performed in 25 patients with critical limb ischemia. Overall survival and limb salvage were determined by Kaplan- Meier analysis. Independent impact on the "primary endpoints" factors was evaluated using log rank test or Cox regression. The rate of complications and reintervention was analyzed.

RESULTS: Mean age was 68 ± 11 years, 17 diabetic patients (68%) and 9 patients on hemodialysis (36 %). Mean follow-up was 380 days. Mean C-reactive protein was 75 mg / L. Overall survival was 97, 88 and 74 % at 3, 6 and 12 months, and remained stable at last observation. The limb salvage was 67 % at 3 months, 55 % at 6 months and 30 % at last observation. Diabetic and ASA 2 patients had a more satisfactory last observation limb salvage, respectively 61 and 75%, p value close to significance. There was statistically significant relationship between mortality and CRF (p = 0.004). One non-succeded reintervention occurred and there was one transient post contrast renal acute failure.

CONCLUSION: In this sample, although survival is high, long term limb salvage is low justified by the very sick population and anatomical issues. ASA classification and diabetes can be an additional prognostic factor of limb salvage.