CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 5, September/October 2022 AFRICA 255 Methods Between January 2014 and March 2020, 139 patients were diagnosed with TAO. Among these patients, 18 with lowerextremity critical limb ischaemia (CLI) underwent endovascular treatment (ET) (Fig. 1). The study was approved by the ethics committee of the Tepecik Training and Research Hospital (2020/6-4). Informed consent was obtained from all patients. Data were retrospectively reviewed from the patients’ clinic and out-patient files. Patients over 18 years of age who had lower-extremity CLI and chronic total occlusion (CTO) of the popliteal artery (PA) and/or infra-popliteal lesions were included. In addition, patients aged 45 years and older with known TAO disease and needing treatment afterwards were included. Asymptomatic patients who then became symptomatic during their follow up were also included. Patients with the possibility of having any other type of vasculitis were excluded using laboratory testing. Patients treated other than with ET options, those with upper-extremity lesions and patients with mild-to-moderate or severe claudication (Rutherford classification 0–3) were also excluded. Patient demographics, co-morbidities, smoking status, clinical status, procedural information, procedural outcome and complications were scanned from the medical records. From the out-patient clinic records, last Rutherford category, wound status, smoking and medication status, duplex ultrasound examination results, major amputations and mortality rates were reviewed (Table 1). The diagnosis of TAO was based on the Shionoya’s criteria.6 Patients presenting with CLI were graded according to the Rutherford classification before and after the procedure: 0, asymptomatic; 1, mild claudication; 2, moderate claudication; 3, severe claudication; 4, ischaemic rest pain; 5, minor tissue Endovascular treatment 22% (22) Surgical treatment 12% (12) Surgical treatment 12% (12) Critical limb ischaemia 77% (99) Lower extremity 92% (128) Minor amputation 19% (19) Major amputation 27% (27) Minor amputation 50% (2) Claudication 23% (39) Intermittant pain 64% (7) Brachial involvement 18% (2) Reynaud phenomenon 18% (2) Upper extremity 8% (11) Medical treatment Surgery bypass Thoracal syphathectomy 139 Patients with TAO M: 89% F: 11% Current study 18% (18) Fig. 1. Selection of patients and overall features of patients with TAO. Table 1. Patient demographics and preprocedural features Variables n (%) or (min–max) Demographics No of patients 18 Mean age (years) 38.8 ± 7.3 (26–49) Male 16 (88.9) Diabetes mellitus 0 (0) IDDM 0 (0) Hypertension 2 (11.1) Dyslipidaemia 0 (0) CAD 0 (0) COPD 0 (0) Smoking 18 (100) Clinical presentation Rutherford 4 (rest pain) 9 (50) Rutherford 5 (minor tissue lost) 6 (33.7) Rutherford 6 (major tissue lost) 3 (16.7) Phlebitis 10 (55.6) Side (right) 10 (55.6) Lesion involvement SFA + PA 2 (11.1) PA + tibial arteries 3 (16.7) Tibial arteries 13 (72.2) Lesion length Anterior tibial artery 180.6 ± 85.6 Peroneal artery 134.7 ± 58.7 Posterior tibial artery 196.0 ± 76.7 Run-off arteries Lateral plantar artery 9 (50) Medial plantar artery 9 (50) Dorsalis pedis artery 6 (33.7) IDDM: insulin-dependent diabetes mellitus, CAD: coronary artery disease, COPD: chronic obstructive pulmonary disease, SFA: superficial femoral artery, PA: popliteal artery.
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