Angioplasty-stenting in breastfeeding lower limb ischemia in Dakar

Abstract

ANGIOPLASTY-STENTING FOR CRITICAL LIMB
ISCHEMIA IN DAKAR
Goal: The aim of this study is to assess the results of the
first endovascular cases in Senegal, West Africa. Method:
This is a prospective study conducted from July 2008 to
July 2009 in a single center, on 38 consecutive patients
who underwent endovascular procedures for critical limb
ischemia. Females represented 58%, and the mean age was
64 years-old (44-82). Most of them had vascular disease -
predicted factors: hypertension 68%, diabetes 58%,smoking 37%, Cardiac disease 26%. Clinical presentation was
dominated by Class 4 of Leriche, with ulcers and toes
necrosis: 73.7%. The ABI was under 0.5 on 84% of patients.
Retrograde femoral approach was mostly used (94.7%).
Angiography permitted to stage the peripheral lesions.
Total occlusion has been found on 42% of cases, while all
of patients had stenosis up to 60%. We used ultra-thin
Diamond, Boston scientific* balloon for angioplasty. Fourty
PTA was done (6 iliac,18 SFA,8 popliteal,2 anterior tibial),
and only 6 stenting (3 iliac, 3 SFA), using 3 wallstent and 3
zilver stents. Manual compression was used for closure.
Femoro-femoral bypass has been done twice as additional
procedure. Heparin was used per-operatively, then Aspirin
or clopidogrel. Results: Three complications occurred
(7.9%): 1 ilio-aortic dissection treated by bypass, 1 cutted
tip of catheter stilling in the SFA, and 1 groin hematoma.
Some re-do procedures had been done: 1 aorto-bifemoralbypass due to dissection, 2 leg amputations (5.3%), 8 forefoot amputations (10.6%), 16 toe amputations (21%), and
2 debridements (5.3%). Two deaths not related to procedure were noticed in the 30 days. After angioplasty, 34
patients (89%) healed their wounds and had pain
decreased without death or major amputation. After 3 to 6
months follow up all the patients had ABI up to 0.6 and
73% had ABI between 0.8 to 1, and duplex ultrasound
showed good patency on 84% (32 patients). Conclusion:
Endovascular surgery is known yet to be an important part
of vascular surgery. Even in under-developed country,
despite limited financial means, PTA is helpful for several
patients, avoiding major amputations