CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 5, September/October 2022 AFRICA 257 Statistical analysis Analyses were performed with IBM SPSS statistics for Mac version 20 (IBMCorp, released 2011, Armonk, NY). Categorical variables were evaluated by cross-table analysis and are shown numerically and as a percentage. Numerical variables are summarised as mean ± standard deviation values. The Student’s t-test was used for the normally distributed data measured on a continuous/interval scale, while the Mann–Whitney U-test was used for the non-normally distributed data. Kaplan–Meier curves were used to compare the outcomes of the subgroups in terms of primary and secondary patency. Cox regression (or proportional hazards regression) was used as a method for investigating the effect of variables on the time a specified event takes to happen. A p < 0.05 was considered statistically significant. Results This study included 18 patients with lower-extremity Buerger’s disease who presented with CLI and were treated with ET. The mean age of patients was 38.8 ± 7.3 (min–max: 26–49) years. The majority of the cohort was male (n = 16, 88.9%). All patients were current smokers at the time of diagnosis. None of the patients had diabetes mellitus. Two patients (11.1%) had a history of hypertension. None of the patients had a history of coronary artery disease. Fifty per cent of patients had rest pain (Rutherford classification 4, n = 9), 33.7% had minor tissue loss and non-healing ulcers (Rutherford classification 5, n = 6), and 16.7% had major tissue loss (Rutherford classification 6, n = 3) on admission. The median duration from initial TAO diagnosis to ET was eight months (min–max: 0–60). All patients had unilateral symptoms, and the right lower extremity was involved more frequently (n = 10 patients, 66.7%). Phlebitis was diagnosed at admission in 10 (55.6%) patients. The majority of lesions were located in the peroneal and tibial arteries (n = 13, 72.2%). Two (11.1%) patients had distal superficial femoral artery occlusion concomitant with popliteal artery (PA) lesions, and three (16.7%) patients had PA occlusion concomitant with peroneal and tibial artery lesions. The mean lesion lengths for the ATA, PTA and peroneal artery were 180.6 ± 85.6, 196.0 ± 76.7 and 134.7 ± 58.7 mm, respectively. All patients had at least one distal run-off vessel. The lateral plantar artery was found as a run-off artery in nine patients and the medial plantar artery was found in nine patients. Six patients had the dorsalis pedis artery accompanied by the medial or lateral plantar artery as run-off arteries. Re-establishment of antegrade flow in at least one vessel was achieved in 15 (83.3%) patients. Because of insufficient recanalisation, the procedure was terminated in three patients. All three patients underwent prostaglandin infusion followed by lumbar sympathetic blockage. No significant differences were found between successful and unsuccessful events in terms of lesion length of the peroneal and tibial arteries (p = 0.54, 0.52, 0.28). Balloon angioplasty was performed in all patients. POBA was used in nine (60%) patients and DEB in six (40%). A rotational atherectomy device was used in three patients. Clinical improvement was observed in 13 patients who underwent successful ET. Two patients needed intra-arterial infusion of vasodilator after ET due to incomplete symptom relief. All patients who had successful ET were discharge from hospital without CLI symptoms. Unplanned amputation was not performed on any patients duringtheiradmission.TwopatientswithRutherfordclassification 6 symptoms on admission had undergone amputation due to the pre-operative condition of their wounds. One patient had first, second and third metatarsal amputation, and another had distal metatarsal amputation. No periprocedural or postprocedural complication was observed. The mean duration of follow up in 15 patients who had undergone successful ET was 21.5 ± 8.1 months (Table 2). The primary CLI-free rate at 12 and 24 months was 80% (66.7% in all patients) (Table 3). Nine patients (60%) needed additional re-intervention due to their CLI symptoms at 24 Fig. 3. Twelve-month follow up of a 49-year-old TAO patient with severe tissue loss after successful endovascular intervention. Table 2. Procedural and postprocedural details Variables n (%) or (min–max) Procedural success 15 (83.3) POBA 9 (60) DEB 6 (40) Atherectomy 3 (20) Stenting 2 (13.3) Clinical improvement 13 (86.6) Intra-arterial vasodilator 2 (13.3) Minor amputation 2 (13.3) Complications 0 (0) Follow up (month) 21.5 ± 8.1 Re-intervention 9 (60) Endovascular 2 (13.3) Lumbar sympathetic blockage 6 (13.3) DEB: Drug-eluting balloon angioplasty, POBA: plain old balloon angioplasty. Table 3. CLI-free rate with regard to type of treatment Primary CLI-free rate DEB POBA p-value 12 months 83 67 0.48 24 months 78 44 0.48 CLI: critical limb ischaemia, DEB: drug-eluting balloon angioplasty, POBA: plain old balloon angioplasty, ATR: atherectomy.
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