• Rashid Usman CMH Lahore Medical College and CMH Hospital Lahore
  • Minahil Mazhar CMH Lahore Medical College
  • Rabail Fatima CMH Lahore Medical College
  • Muhammad Jamil CMH Multan
  • Shahid Majeed CMH Lahore Medical College



angioplasty, limb ischemia, infrapopliteal, limb salvage


Background: Peripheral arterial disease (PAD) affects a substantial proportion of the global population, particularly older individuals, affecting around 200 million people worldwide highlighting its significant impact on human health. Critical limb ischemia (CLI) is the most severe clinical presentation of PAD characterized by ischemic rest pain tissue ulceration or gangrene. The objective of the study is to assess the efficacy of infra popliteal angioplasty (in terms of wound healing and limb salvage) in patients with below-the-knee total chronic occlusion (TCO). Methods: In this cross-sectional study, all consecutive patients in one year with TCO and fulfilling the inclusion criteria were included. Results: A total of 64 limbs underwent angioplasty. The mean age was 55.38 ± 13.12 (Range 22-88) years and there were 73% (n=47) males. Diabetes mellitus was the most prevalent risk factor in 59.4% (n=38) of patients. 48.4 % (n=31) of patients had below-knee TCO in all three arteries. Technical Success was achieved in 95.3% (n=61/64). All 3 patients who had technical failure ended up with below-the-knee amputation. Furthermore, 2 more patients who had technical success also ended up with below-the-knee amputation. The difference between these two rates was significant (100% vs 3.3%; p-value =0.004). In terms of wound healing, statistically significant improvement was noted within the first 6 months (p-value = 0.05). The limb salvage rate was 90.6% (n=59/64). The primary patency rate was 81.3% (n=52) and 76.6% (n=49) at 6 and 12 months respectively. Conclusion: Angioplasty results in statistically significant wound healing leading to a higher limb salvage rate, in patients with TCO of infrapopliteal arteries.

Author Biographies

Rashid Usman, CMH Lahore Medical College and CMH Hospital Lahore

Assistant Professor of Surgery Department of Surgery CMH Lahore Medical College

Minahil Mazhar, CMH Lahore Medical College


Rabail Fatima, CMH Lahore Medical College



Shamaki GR, Markson F, Soji-Ayoade D, Agwvegbo CC, Bamgbose MO, Tamunoinemi BM. Peripheral Arterial Disease: A comprehensive updated review. Curr Probl Cardiol 2022;47(11):101082.

Armstrong EJ, Armstrong DG. Critical limb ischemia. Vasc Med 2021;26(2):228–31.

Karimi A, Lauria AL, Aryavand B, Neville RF. Novel Therapies for critical limb-threatening ischemia. Curr Cardiol Rep 2022;24(5):513–7.

Barnes AJ, Eid MA, Creager MA, Goodney PP. Epidemiology and Risk of Amputation in Patients with Diabetes Mellitus and Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2020;40(8):1808–17.

Giannopoulos S, Varcoe RL, Lichtenberg M, Rundback J, Brodmann M, Zeller T, et al. Balloon Angioplasty of Infrapopliteal Arteries: A Systematic Review and Proposed Algorithm for Optimal Endovascular Therapy. J Endovasc Ther 2020;27(4):547–64.

Vivekanand V ,Motukuru V, Kolalu S, Rangaswamy GK, Jain P. Effect of Comorbidities on Outcomes of Infrapopliteal Angioplasty in Patients with Chronic Limb-Threatening Ischemia. Innovations (Phila) 2022;17(5):392–400.

Dave B, Shah R. Peripheral stent technology and current status for endovascular treatment of femoropopliteal artery disease: a clinical review. Int J Res Med Sci 2018;6(5):1474–83.

Cerqueira LO, Duarte EG, Barros ALS, Cerqueira JR, Araujo WJB. WIfI classification: the Society for Vascular Surgery lower extremity threatened limb classification system, a literature review. J Vasc Bras 2020;19:e20190070.

Farber A, Menard MT, Conte MS, Kaufman JA, Powell RJ, Choudhry NK, et al. Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia. N Engl J Med. 2022; 387(25):2305-16.

Huizing E, Schreve MA, De Vries JPM, Ferraresi R, Kum S, Unlu C. Below-the-Ankle Angioplasty in Patients with Critical Limb Ischemia: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2019;30(9):1361–68.e2.

Park SW, Kim JS, Yun IJ, Hwang JJ, Lee SA, Chee HK, et al. Clinical outcomes of endovascular treatments for critical limb ischemia with chronic total occlusive lesions limited to below-the-knee arteries. Acta Radiol 2013;54(7):785–9.

Mustapha AA, Adams G, Gray W, Hershon S, Diaz-Sandoval LJ, Jaff MR, et al. Determinants of long-term outcomes and costs in the management of critical limb ischemia: a population-based cohort study. J Am Heart Assoc 2018;7(16):e009724.

Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017;135(12):e726–79.

Ferraresi R, Centola M, Ferlini M, Ros RD, Caravaggi C, Assaloni R, et al. Long-term outcomes after angioplasty of isolated, below-the-knee arteries in diabetic patients with critical limb ischemia. Eur J Vasc Endovasc Surg 2009;37(3):336–42.

Sadek M, Ellozy SH, Turnbull IC, Lookstein RA, Marin ML, Faries PL, et al. Improved outcomes are associated with multilevel endovascular intervention involving the tibial vessels compared with isolated tibial intervention. J Vasc Surg 2009; 49(3):638–44.

Additional Files



Most read articles by the same author(s)

1 2 > >>