Effect of balloon angioplasty on inframalleolar stenosis in patients with chronic limb-threatening ischemia.

Background: Although there are reports on angioplasty for inframalleolar (IM) occluded lesions in chronic limb-threatening ischemia (CLTI), the clinical outcomes specific to the IM stenotic lesions remain unclear. This study evaluated the effect of balloon angioplasty for IM stenotic lesions on the clinical outcomes of patients with CLTI.

Methods: This is a multicenter, retrospective, nonrandomized observational study. We retrospectively analyzed 194 patients with CLTI who underwent endovascular therapy for infrapopliteal (IP) lesions with IM stenotic lesions distal to the target IP lesion between November 2017 and August 2022. Angioplasty for IM stenotic lesions was performed in 99 patients. Outcome measures included wound healing rate, amputation-free survival (AFS), and freedom from reintervention. Propensity score matching was conducted to reduce baseline differences.

Results: Propensity score matching extracted 69 pairs with no significant baseline differences. The wound healing rate was not significantly different between the angioplasty and nonangioplasty groups (64.0% vs 59.6%, p = 0.94). Similarly, no significant differences were observed in AFS (82.4% vs 82.2%, p = 0.94) and freedom from reintervention (51.1% vs 46.6%, p = 0.81). However, the lesion morphology at reintervention progressed from stenosis to occlusion more frequently in the angioplasty group than in the nonangioplasty group (39.3% vs 12.9%, p = 0.035). Multivariate analysis identified angioplasty in IM lesions as an independent predictor of lesion morphology progression in IM lesions.

Conclusion: Angioplasty was associated with a higher rate of lesion morphology progression, which should be considered when determining treatment strategies.