Pedal Artery Angioplasty in Patients with Diabetes and the Alchemy of Turning Stone into Flow: A Review - Abstract
Objective: Chronic limb-threatening ischemia (CLTI) resulting from multilevel arterial occlusive disease carries a high risk of limb loss and mortality. Because scarcely analyzed in contemporary literature, our study proposes a specific review of available pedal artery angioplasty (PAA) indications and clinical results in CLTI, particularly in patients with diabetes.
Methods: We examined PAA application and outcomes in CLTI, specifically in patients with diabetes, by analyzing data from the PubMed, Medline, and available online databases.
Results: After the initial identification of 881 publications that matched the present research criteria, 16 articles were selected for PAA analysis, from which only 4 exclusively focused on patients with diabetes. While 2 articles analyzed isolated PAA applications in CLTI, 12 others studied the clinical utility of PAA in association or non-association with above-the-ankle (ATA) angioplasty. Because of the huge heterogeneity in the profile of these studies, absence of standardized reference groups, insufficient clinical data, low level of prospective information, and absence of randomized controlled analysis, optimal level of data evidence was not attainable.
Technical success rates for PAA varied between 76% and 93% of treated cases. Statistically superior wound healing and limb salvage rates were observed after applying PAA either alone or in tandem with ATA angioplasty in CLTI treatment. However, amputation-free survival (AFS) was not influenced by PAA in 4/14 (29%) of the selected studies.
Conclusions: Standardized indications, uniform clinical evaluation, and acceptable levels of evidence are missing in current investigations concerning PAA. Despite the scarce documentation of clinical outcomes, PAA alone or in combination with ATA angioplasty seems to afford better wound healing and limb preservation rates but does not improve AFS. While some authors describe lower feasibility and clinical success rates in patients with diabetes, others do not. Further standardized and prospective studies are required to validate the clinical usefulness of PAA.