Prediction of Success of Angioplasty in Patients with Critical Limb Ischemia Suffering Isolated Inframalleolar Disease

Background: Chronic limb-threatening ischemia (CLTI) from isolated inframalleolar disease is associated with poor wound healing and high amputation rates, despite advances in revascularization techniques.
Objectives: To assess clinical outcomes and detect predictors of success of inframalleolar angioplasty in patients diagnosed with chronic limb-threatening ischemia. Patients and Methods: In this prospective study, 44 CLTI patients with tissue loss or rest pain underwent inframalleolar angioplasty via an ipsilateral anterograde femoral approach. Pre- and post-procedure hemodynamics (toe-brachial index and duplex velocities in pedal vessels), technical success, complications, and 12-month wound-healing outcomes were recorded. Disease severity was staged by the WIFI and GLASS systems.
Results: The cohort (mean age 68 ± 10 years; 64% male) exhibited high rates of diabetes (70%) and hypertension (78%), with a baseline mean toe-brachial index of 0.28 ± 0.10. Following angioplasty, mean toe-brachial index increased to 0.37 ± 0.14, and duplex velocities in all target arteries improved significantly (p < 0.001). Technical success was achieved in 92% of cases. Major adverse limb events occurred in 28%, with amputation and mortality rates of 13.6% each. Lesion length over 10 cm, severe inframalleolar disease, and diabetes independently predicted technical failure. At twelve months, 75% of patients achieved complete wound healing, 80% remained amputation-free, and 65% were free from major limb events; median healing time was longer in severe disease. Conclusion: Inframalleolar angioplasty yields good technical success and clinical benefits, though long lesions, advanced disease, and diabetes worsen outcomes.