December 23, 2005

Flanders Experience with Endovascular Treatments for BTK-lesions in CLI-patients: the FEET-BTK study.

Michael B. Silva, Jr.¹, Koen Deloose¹, Jurgen Verbist², Patrick Peeters².
¹AZ St-Blasius, Dendermonde, Belgium, ²Imelda Hospital, Bonheiden, Belgium.
OBJECTIVE
Presently, endovascular strategies exist for the treatment of infrageniculate PAOD. However, beyond technical feasibility, only limited evidence supports their use for BTK-interventions. We studied the 1-year outcome of excimer laser recanalization, PTA only, PTA followed by stenting and primary stenting for BTK-lesions in CLI-patients.
METHODS
Between September 2002 and June 2005, 381 patients (299 Rutherford category 4, 76 category 5, 6 category 6) underwent intervention for 587 BTK-lesions. Follow-up was performed at least every six months after index intervention: limb salvage data were recorded and duplex ultrasound was performed to measure treated area patency.
RESULTS
The 1-year survival, primary patency and limb salvage rates of the entire population were 89.1%, 74.9% and 96.9% respectively. Stratified for the treatment strategy (excimer laser in 63, PTA alone in 64, PTA followed by stenting in 173 and primary stenting in 81 patients), 1-year primary patencies were 76.5%, 74.9%, 73.8% and 76.3%, while the limb salvage rates were 87.5%, 96.0%, 99.3% and 100%, for each modality respectively.
CONCLUSIONS
Endovascular intervention should be the primary treatment for BTK-lesions in CLI-patients, with 1-year survival, primary patency and limb salvage rates that compare favorably with published surgical data. Prospective, randomized, multicenter trials will be needed to further establish the role of endovascular intervention in this challenging patient group.

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