الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Peripheral atherosclerotic disease affects 12%–14% of the general population, and its prevalence increases with age, affecting as many as 20% of patients older than age 75 years.
Critical limb ischemia is defined as limb pain that occurs at rest, or impending limb loss that is caused by severe compromise of blood flow to the affected extremity. The international consensus on the definition of CLI is the following: any patient with chronic ischemic rest pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease.
Risk factors contributing to PAD are the same as those for atherosclerosis: Smoking - tobacco (tenfold increase in risk for PVD), Diabetes mellitus (two and four times increased risk of PVD), Dyslipidemia, Hypertension, age over 50, gender (male), obesity, or with a family history of vascular disease.
The diagnosis is usually made by the typical symptoms. A simple test that can be done is to check the blood pressure in the ankle and compare this to the blood pressure in the arm. This called the ankle brachial pressure index (ABPI). If the blood pressure in the ankle is much different to that in the arm that means that arteries of lower limb are affected. CT angiography or arterial duplex can build up a ’map’ of the arteries and show where they are narrowed.
Once the diagnosis is confirmed, the goals of treating CLI are to relieve ischemic pain, heal ischemic ulcers, prevent limb loss, improve patient function and Quality of Life, and prolong survival. Revascularization could optimally achieve these goals, but the severity of comorbidities, along with durability of the reconstruction in patients with CLI, demands a risk-benefit analysis to determine the optimal therapy.
There are different modalities of management of lower limb ischemia. The conservative measures; involving regular exercise, smoking cessation, blood pressure control, good glycemic control and regulate of lipid level. Medications that improve the peripheral blood flow, such as antiplatelet agents. Surgical re-vascularization is another alternative (as bypass grafting). However;PVD(arterial occlusive lesions) infragenicular are not usually amenable for surgical bypass. Angioplasty is an expanding era where dilatation of narrowed or occluded arterial segment (with or without stenting) can be achieved as a minimal invasive technique
Percutaneous tranluminal angioplasty(PTA) and other methods of percutaneous revascularization have become established as effective therapy for selected patients with peripheral occlusive diseases and has since gained acceptance owing to reported improvements in outcome and diminished rates of morbidity and mortality compared with standard surgical bypass. .
This project aims to assess the outcome of percutaneous tranluminal angioplasty(PTA)using long balloon catheters(≥15cm) in treatment of critical lower limb ischemia caused by infra-popliteal arterial lesions and compare its results with that of previous studies used shorter balloon catheters.
There is little documentation of the effectiveness of percutaneous balloon angioplasty (PTA) of infrapopliteal
vessels using long balloon catheters for the treatment of CLI. This study reviewed our recent experience with infrapopliteal PTA in a group of patients to determine its effectiveness as a treatment modality
To conclude, endovascular treatment of BTK lesions is a valid and robust therapy for CLI, with excellent results ( either long or short balloon catheters as there is no significant difference in their results). We anticipate that endovascular intervention will become the primary treatment for BTK lesions in CLI patients, with 1-year primary patency, limb salvage, and survival rates that compare favorably with published surgical data. Prospective, randomized, multicenter trials will be needed to further establish the role of endovascular intervention and the different techniques necessary in this challenging patient group.
Infrapopliteal angioplasty can be performed safely with favorable results in patients with limited longevity. Primary patency is related to disease extent. Secondary interventions may be necessary to maintain clinical success.
Advantages of long balloon catheters includes decreased procedural time, decreased radiation exposure, less vessel occlusion time and risk of thrombosis, Less risk of emboli resulting from advancing or withdrawing winged balloons across diseased segments and less risk of dissection as dilation is from normal segment distally to normal segment proximally
The advantage of long balloons especialy if it is of low-profile is most clearly evident in cases of complex distal revascularization such as those involving the pedal arch. In these cases, the diseased arch can be easily treated with a single balloon covering complicated anatomy of the most of the lesion area, resulting in better arterial remodeling.
Infrapopliteal PTA with a long balloon was feasible, with encouraging midterm outcome, in the treatment of severe limb ischemia. The limited sample size in this study does not enable however a definitive appraisal of the clinical role of this type of balloon catheters so Further studies are necessary to evaluate long-term outcome.