OBJECTIVETo evaluate the efficacy of infrapopliteal angioplasty as the first-choice procedure in patients with critical lower limb ischemia.

METHODSFrom December 2005 to May 2009, infrapopliteal angioplasty was considered as the first-choice method in consecutive patients with infrapopliteal occlusive disease hospitalized for critical ischemia. Fifty-four patients (61 limbs) with a mean age of 66 years old (37 male and 17 female) underwent infrapopliteal balloon angioplasty. The preoperative ankle branchial index (ABI) was 0.43 + or - 0.27.

RESULTSIliofemoral artery revascularization (stenting in 28 limbs and bypass in 5 limbs) were successful. Infrapopliteal balloon dilation was success in 57 limbs, the technical success rate was 93.4%. The major complications were calf hematoma in 3 cases (4.9%), and below-the-knee amputation in 2 cases (3.3%). Postoperative ABI increased to 0.86 + or - 0.21(P < 0.01). Mean follow-up time was (16 + or - 11) months. The primary patency rate was 61.1%, restenosis rate was 38.9% (21 of 54 limbs), and surgical intervention were performed for 10 limbs, the secondary patency rates was 75.9%. Major amputation in 3 limbs during follow-up period, the limb salvage rate was 91.8%.

CONCLUSIONInfrapopliteal balloon angioplasty as the first-choice method is feasible, safe and effective for limb salvage in patients with critical lower limb ischemia.