Background: Lower extremity peripheral arterial disease (PAD) is a major cause of morbidity and mortality. 
Percutaneous endovascular therapy is an alternative to surgery for the treatment of PAD. While 
infrapopoliteal PTA was restricted to patients with short stenotic lesions or poor candidates for bypass, 
recently it has been used preferentially over bypass surgery by some groups due to the advent of new devices 
and techniques. The growing experience with endovascular therapy justifies an assessment of crural PTA. The 
aim of this study is reviewing our results in infrapopliteal angioplasty stratifying patients by anatomic 
characteristics according to the TASC classification.
Patients and Methods: This study was conducted at Arab Contractors Medical Center and Mansoura 
University Hospital on 80 patients during the period from Jan 2009 till April 2013. Inclusion criteria were rest
pain, ulceration and tissue necrosis. Exclusion criteria were life threatening infection, Burger's disease and 
multilevel lesions. All patients were investigated by colour duplex scan, C.T.Aor M.R.A. The TASC “I" 
classification for tibioperoneal occlusive disease was done. All procedures were done with local anesthesia, 
sometimes sedation was needed for irritable patients.
Cases were performed preferentially through antigrade ipsilateral femoral access and rarely through 
retrograde contralateral access. All patients were anticoagulated with 10,000 IU heparin after initial 
angiography.
We used 6F sheaths for ipsilateral antigrade access and 8F sheath for retrograde contralateral access, 4F 
vertebral catheters were used with 0.035 floppy angled giudewire (Terumo, Somerest, ND), 0.018, 0.014 
hydrophilic wire (Boston Scientific, Natick, Mass) or glide wire. Five cases had direct tibial vessel puncture 
using fluoroscopic guidance had been done. Angioplasty was performed with low profile balloon 
(Amphirion Deep, Invatec, Italy) 2.5 to 3F. Balloon was inflated for 1 to 3 minutes. 
If vasospasm occurred; administration of 50-400 mcg of nitroglycerin was helpful.
After the procedure, patients were given 600 mg loading dose of clopidogrel, if the patient didn't receive it 
preoperatively, maintained on 75 mg daily dose for 3 months to one year, along with aspirin and statins.
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Results: During the study period, 80 patients underwent PTA [14 (17.5%) for rest pain and 66 (82.5%) for 
tissue loss] after exclusion of five cases from the study due to failure of guide-wire passage. Antigrade access 
was used in 73 cases (91.25%) and seven cases (8.75%) retrograde access was performed due to difficult 
puncture. Primary patency was 58.75% at first year and 48.75% at second year.
First year primary patency for TASC A through D was 83.3%, 87.5%, 45%, 34.6% respectively. And for 
Second year was TASC A through D was 72.2%, 68.75%, 40%, 26.9% respectively. Limb salvage at 1 year: 81%,
and at 2 year: 75%.
Conclusion: PTA is recommended as first line of treatment for TASC A, B, C lesions and TASC D patients 
who are not candidate for bypass. But more studies are needed to compare long term follow up between PTA 
and bypass in TASC D lesions.