Acute occlusion of popliteal and/or tibial arteries: the value of percutaneous treatment.
OBJECTIVE
to describe early and mid-term results with a percutaneous therapeutic protocol including thromboaspiration, thrombolysis, and correction of the underlying lesion by PTA.


METHODS
thirty-three consecutive selected patients with recent (<1 month) reversible acute ischaemia associated with popliteal and/or tibial occlusion were studied. The primary endpoints were technical success (defined as residual mural thrombus less than 20% of the lumen and the presence of at least one tibial artery on angiogram), patient survival and limb salvage at 1 and 12 months. Secondary endpoints included complications, primary, assisted primary and secondary patency determined by duplex scan at 1, 6 and 12 months.


RESULTS
technical success was achieved in 27 patients (82%). Twenty patients were treated by thrombo- aspiration+/-thrombolysis only, and seven required additional PTA (26%). In six patients (18%), percutaneous techniques failed, and embolectomy was performed in two, bypass in one and major amputations in three (9%). For the entire series, the survival rate was 100% at 1 month and 94% at 1 year. The limb salvage rate was 91% at 1 month and 1 year. The cumulative primary patency, assisted primary patency and secondary patency rates were 81%, 81% and 86% respectively at 1 month and 66%, 72% and 77%, respectively, at 12 months. Early complications occurred in 10 patients (30%): five groin haematomas (15%), four compartment syndromes (12%) and one haemoglobinuria (3%).


CONCLUSIONS
percutaneous techniques offer excellent early and mid-term results in selected patients presenting with acute ischaemia with popliteal and/or tibial arteries occlusion.
Desgranges
P
P
Service de Chirurgie Vasculaire, Hôpital Henri Mondor, 51 avenue du Mal de Lattre de Tassigny, Créteil, 94000, France.
Kobeiter
K
K
d'Audiffret
A
A
Mellière
D
D
Mathieu
D
D
Becquemin
J P
JP
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000145:classification / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D017128:Embolectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use; D011150:Popliteal Artery; D011859:Radiography; D013396:Suction / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D016909:Tibial Arteries; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014654:Vascular Patency
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator