الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Critical lower limb ischemia becomes wide spread in the last time and represented by the occurrence of continuous pain in the foot not related to any effort and foot ulcers or gangrene. One of the most important pictures of the disease that require rapid intervention for the improvement of blood flow to the lower limb, that leads after that to improve the survival rate of the patient. The treatment of critical lower limb ischemia is by surgical bypass grafting or by endovascular treatment with balloon angioplasty. Percutaneous balloon angioplasty improves outcomes in CLI and has increasingly become the first-line of treatment in critical lower limb ischemia compared with surgical bypass grafting. One of the most important causes of critical lower limb ischemia is atherosclerosis. Critical lower limb ischemia is a multilevel disease and associated with other diseases with decreased life expectancy of the patient. The care of the patients with CLI is not straight forward because many of them have significant co-morbidities including renal disease and advanced age that further contribute to the overall morbidity, mortality, dependency and poor life satisfaction.
Percutaneous balloon angioplasty improves outcomes in CLI and has increasingly become the first-line of treatment for diabetic patients with CLI. Compared to surgical bypass grafting, the endovascular treatment have the advantages of being minimally invasive, associated with less morbidity and mortality, shorter hospital stay, can be repeated and preserve the saphenous vein.
The role of endovascular intervention in the treatment of limb-threatening ischemia is also expanding and its promise of limb salvage and symptom relief with reduced morbidity and mortality makes percutaneous transluminal angioplasty with or without stenting an attractive alternative to surgery.
With the advent of fine wires, small gauge catheters and greater operator experience in other vascular territories, infrapopliteal percutaneous transluminal angioplasty (PTA) has been increasingly applied to patients with critical limb ischemia (CLI).
According to the Transatlantic Intersociety Consensus (TASC) document on Management of Peripheral Arterial Disease (PAD) tibial arterial lesions are classified into four groups: A, B, C and D. Endovascular treatment is recommended for groups A and B. However, due to the improvements in equipment and technique, endovascular therapy is now considered a feasible option in groups C and D.
Below the knee angioplasty is feasible. It provides good medium term clinical outcome in a group of patients with limited treatment options. It is used as an adjunct to proximal angioplasty to increase the limb salvage rate.
This study was undertaken in an effort to evaluate the efficacy of angioplasty as a primary choice for the management of infra -inguinal critical lower limb ischemia compared with surgical approach in aretrospective manner.
This is a prospective study conducted on 50 patients presented with infra-inguinal critical lower limb ischemia to Shebin El-Kom Teaching Hospital along the period of March 2015 to November 2016 and treated by Endovascular treatment compared with a retrospective study of another 50 patients also presented by infra-inguinal lower limb ischemia and treated by open surgery.
Patients with Rutherford IV, V, and VI were 24, 17 and 33 respectively. Level of occlusions included, SFA, popliteal and crural in 47,19,34 respectively. Multilevel diseases were encountered in 85 patients. 50 patients were treated by endovascular and 50 patients needed surgery. Tackling of lesions by subintimal and intraluminal were in 3 and 97 respectively. Technical success was in endovascular and open is 93%, 85% respectively. On 12 mon6ths follow up 1ry patency, 2ry patency, limb salvage in 77.8%, 84.7% and 90.7% respectively. The overall mortality was 3%. Multiple lesions, length of lesions > 10 cm, subintimal passage lowered the technical success, patency rate, limb salvage.