الفهرس 
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Abstract
Advances in endovascular therapies during the past decade have broadened the options for treating peripheral vascular disease percutaneously. Endovascular treatment of infrapopliteal PAD offers a lower risk alternative to open surgery in many patients with multiple comorbidities.
Our series included 108 limbs in 104 patients presenting with Stage IIb, III, and IV Fontaine/ Rutherford categories 3,4,5 and 6. These patients received treatment at Johan Wolfgang Von Goethe University Hospital in Frankfurt, Germany and at Assiut University Hospital, Assiut, Egypt.
Mean age was 71.2 years; 62% were associated with diabetes; 25.9% gave history of smoking; 43% were hypertensive; 48.1% had concomitant coronary artery disease; 6.4% had previous major amputation. Balloon angioplasty was performed in 73.1%, while bare metal stents were used in 17.6%. Drug eluting balloons and stents were used in 7.4% and 0.9%, respectively. The overall technical success rate was 94.2%. Mean follow up period was 7.1 months. Complications occurred in 13.9% of cases in the form of dissection (5.5%), vessel perforation(1.9%), False aneurysm (2.8%), distal thrombosis (2.8%), hematoma (0.9%).
Cumulative percentage of primary patency at 1, 6, 12, 24 months was
92.9%, 79.3%, 69.5%, and 58.3 %, respectively. This was adversely affected by smoking (p=0.005). A redo PTA was needed in 8 cases (7.4%) in the form of balloon dilatation (6), and dilatation with stenting (2). A secondary bypass was needed in 6 cases (5.5%).
Amputation free survival was 6.7±7.9 months. Smoking, diabetes and updated TASC II class were found to be significantly different (p=0.009, 0.023, and 0.018, respectively), with only 8 patients (7.4%) having undergone major amputations. Seven patients died in the perioperative period, 6 of them due to cardiac causes, and 1 due to renal causes. Patient survival was adversely affected by smoking and history of major amputation.
Infrapopliteal PTA is a safe, successful, and effective technique for treatment of critical limb ischemia, with an excellent technical success rate, and a low peri-procedural morbidity and mortality. Although the mid-term primary patency is less than 70% in most studies, excellent limb salvage rate can be achieved with meticulous wound care using surgical and biological debridement techniques in addition to negative pressure (VAC) therapy of open wounds.Future improvement will probably include better patency-enhancing drug coating for balloons and stents. In addition future development of adjunctive endovascular devices, including atherectomy, cryoplasty, cutting balloons, and laser is expected, which until now continue to show no superiority over the conventional PTA techniques.