الفهرس 
Acknowledgment
Drug Coated BalloonsOnly 14 pages are availabe for public view
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Abstract
from October 2019 to October 2021, we conducted a prospective study comprising 25 patients who underwent endovascular treatment of chronic lower limb ischemia due to SFA-ISR. The patients were evaluated by full history taking, clinical examination, laboratory especially renal function and imaging investigations especially duplex scan. The following criteria were studied: Age and sex, risk factors, clinical presentation, and lesion characteristics (degree of stenosis, distal run-off vessels, lesion length) Primary end point was primary patency defined as PSVR<2.4 documented by duplex ultrasound at 12 months without target lesion revascularization. Secondary endpoints were technical success rate, 12 months major adverse events (MAEs) rate including death, major amputations and TLR. There were 19 (76%) males and 6 (24%) females with mean age of 63.88± 5.16 years (range; 53-71 years). All the patients in this study had one or more risk factors such as diabetes mellitus (DM) 52%, smoking (52%), Hypertension (72%), coronary artery disease (32%), hyperlipidemia (12%). Critical limb ischemia was the indication for revascularization (Rutherford category 4 to 6) with >50% stenosis detected by Duplex ultrasonography with at least one distal run-off vessel. 36% of patients were Rutherford IV, 56% were Rutherford V and 8% were Rutherford VI. Angiographic classification of the lesion showed 24% patients were Tosaka I, 60% were Tosaka II and 16% were Tosaka III. Also, angiographic study showed that 48% of patients had one patent distal run-off vessel, 28% had two distal run-off vessels, and 24% had three distal run-off vessels. The mean lesion length was 85.400 ± 35.44, range (35mm-150mm). In this study, (78.2%) of patients underwent endovascular treatment using drug coated balloons and (21.8%) of patients underwent endovascular treatment using Plain old balloon angioplasty. This study revealed an overall success rate of 92%. We failed to cross the lesion in 2 patients. Post operatively the mean ABI increased significantly from 0.528± 0.106 to 0.99 ±0.073 (P < 0.0001). Complications occurred in 26% of patients in the form of dissections (13%), pseudoaneurysm at CFA (4.3%) and access site hematoma (8.6%). The Primary Patency rate at 12 months was 82.6%. No patients lost or died during the follow up period. A redo PTA was needed in 2 patients in the form of DCB. A secondary bypass surgery was needed in 3 cases. One patient (4%) underwent major amputation in the form of AKA in the ninth month. Endovascular treatment of chronic lower limb ischemia due to SFA-ISR is a safe and effective technique. Both Plain old balloon angioplasty and DCB has low peri-procedural morbidity and mortality. It is an excellent alternative to surgery with high technical success rate. Drug coated balloon angioplasty is a favorable technique due to the anti-proliferative properties of paclitaxel with significant reduction in recurrent stenosis and repeat angioplasty up to 1 year.