Introduction: It is well known that atherosclerotic involvement in diabetic patients with critical limb ischemia (CLI) mainly affects below-the-knee (BTK) arteries. But the therapeutic efficacy of percutaneous transluminal angioplasty (PTA) in such patients has not been clearly defined.
Aim: This study aims to assess the clinical success and the limb-salvage rates for infragenicular angioplasty as the initial treatment of critically ischemic lower limbs in diabetic patients.
Materials and methods: From December 2006 to October 2008, a consecutive series of 64 limbs in 54 diabetic patients with critical limb ischemia (Rutherford categories 4,5,6) were treated by primary infragenicular angioplasty. Our primary end points were immediate technical success, sustained clinical improvement, haemodynamic outcome, and limb salvage rate. Secondary end points were periprocedural complications and 30-day all cause mortality.
Results: The mean age of our 54 patients was 62 years (48-70 years). The initial technical success was achieved in 94% of procedures, with limb salvage rate of  100%, 95%, 89%, and
84% at 1, 3, 6, and 12 months respectively, haemodynamic improvement of 96%, 89%, 79%, and 60% at 1, 3, 6, and 12 months respectively, and sustained clinical improvement of 100%,95%, 89%, and 84% at 1, 3, 6, and 12 months respectively,. The periprocedural adverse events occurred in 5 (7.8%) procedures, and the 30-day all cause mortality was 1/54 (1.85%).
Conclusion: Primary infragenicular angioplasty for limb salvage in the diabetic patient population represents an efficacious method to improve wound healing in critically ischemic limbs, taking into consideration the fragile nature and co-morbidities in such selected patient population.