title: Tibial angioplasty as an alternative strategy in patients with limb-threatening ischemia.
abstract: The purpose of this study was to assess the technical feasibility and early outcome of tibial angioplasty for a subset of patients with limb-threatening ischemia who were not candidates for bypass grafting. A retrospective analysis was conducted of 19 patients (7 male, 12 female) who underwent crural angioplasty for limb-threatening ischemia using 0.018- or 0.014 inch-based systems. Contraindications to bypass were insufficient conduit in 7 patients and severe comorbid illness in 12. Concurrent treatment of inflow lesions was performed in 12 of 20 limbs via either angioplasty alone (5) or combined with stenting (12). Outcome measures were ankle-brachial indices (ABI), relief of rest pain, and healing or healed wounds. Twenty-three vessels were treated, including 14 tibial occlusions and 9 stenoses. The average length of diseased segment was 11 cm (range, 3-25 cm). Thirteen of 14 occlusions were treated with subintimal recanalization, the remainder with laser recanalization. Technical success was achieved in 22 of 23 treated vessels. Mean preoperative ABI was 0.53 and mean postoperative ABI was 0.85. Palpable pulses were present in 11 of 20 limbs (55%). There was one perioperative mortality (5.2%). Mean follow-up was 3 months. Three failures occurred requiring amputation (15.8%). The remaining 16 patients were improved with healing (8) or healed (4) wounds and relief of rest pain (4). These results indicate that technical success may be achieved with outflow lesion angioplasty in the majority of patients encountered. The durability of this method of therapy is unknown, and our length of follow-up is not sufficient to answer this question. However, an attempt at angioplasty appears justified before primary amputation and before surgical bypass in those patients at high risk for intervention.
authors.affiliation: Division of Vascular Surgery, New York-Presbyterian Hospital, Columbia College of Physicians and Surgeons and The Weill Cornell Medical School, New York, NY 10032, USA. claird@ccf.org
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Clair
authors.forename: Rajeev
authors.initials: R
authors.lastname: Dayal
authors.forename: Peter L
authors.initials: PL
authors.lastname: Faries
authors.forename: Joshua
authors.initials: J
authors.lastname: Bernheim
authors.forename: Roman
authors.initials: R
authors.lastname: Nowygrod
authors.forename: John C
authors.initials: JC
authors.lastname: Lantis
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Beavers
authors.forename: K Craig
authors.initials: KC
authors.lastname: Kent
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D017130:Angioplasty / Q000295:instrumentation / Q000379:methods; D016342:Angioplasty, Laser; D000842:Ankle / Q000098:blood supply; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology; D001916:Brachial Artery / Q000502:physiology; D003251:Constriction, Pathologic / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D059408:Pain Management; D012189:Retrospective Studies; D015607:Stents; D016909:Tibial Arteries / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology