Objective This study investigated the incidence and clinical relevance of the slow-flow phenomenon after infrapopliteal balloon angioplasty. Methods This retrospective, single-center study included 161 consecutive patients with critical limb ischemia (173 limbs) who underwent endovascular treatment for infrapopliteal lesions between January 2012 and May 2015. The overall technical success rate was 88%. Of these lesions, 30 limbs presented with slow flow after angioplasty. Results Total occlusion (90% vs 63%; P <.01) and severe calcification (43% vs 8%; P <.01) were more common in the slow-flow group. Kaplan-Meier curve analysis revealed that freedom from major amputation (60% vs 86%; log-rank, P < .01) and wound healing at 2 years (77% vs 91%; log-rank, P =.03) were significantly less common in the slow-flow group. Univariate Cox proportional hazard analysis identified Rutherford class 6 (hazard ratio [HR], 6.4; 95% confidence interval [CI], 2.8-15.8; P <.01), the slow-flow phenomenon (HR, 3.9; 95% CI, 1.6-8.9; P <.01), and hemodialysis (HR, 3.2; 95% CI, 1.2-11.1; P =.02) as independent predictors of major amputation and Rutherford class 6 (HR, 0.3; 95% CI, 0.2-0.6; P <.01), the slow-flow phenomenon (HR, 0.5; 95% CI, 0.3-0.9; P =.02), and pedal arch (HR, 1.6; 95% CI, 1.0-2.5; P =.04) as predictors of wound healing. Conclusions The slow-flow phenomenon after infrapopliteal balloon angioplasty occurred in 18.6% of limbs. This phenomenon may result in poor outcomes.
Tokuda, T., Hirano, K., Sakamoto, Y., Takimura, H., Kobayashi, N., Araki, M., … Ito, Y. (2017). Incidence and clinical outcomes of the slow-flow phenomenon after infrapopliteal balloon angioplasty. Journal of Vascular Surgery, 65(4), 1047–1054. https://doi.org/10.1016/j.jvs.2016.08.118