title: Improved outcomes are associated with multilevel endovascular intervention involving the tibial vessels compared with isolated tibial intervention.
abstract: OBJECTIVE
  Endovascular intervention is increasingly accepted as an alternative to surgery for the treatment of tibial vessel disease. Tibial vessel disease can occur in isolation or in conjunction with disease that involves the proximal lower extremity vasculature (multilevel disease). This study evaluated the overall efficacy of endovascular intervention for tibial vessel disease and whether the requirement for single-level compared with multilevel intervention affected outcomes.
  
  
  METHODS
  This study evaluated a consecutive unselected group of patients who underwent an infrapopliteal intervention from November 2002 to February 2008. The primary end points evaluated were technical success, limb salvage, primary patency, and secondary patency. The secondary end points evaluated were 30-day access site (ie, hematoma, pseudoaneurysm, and wound infection), intervention site (ie, thrombosis), and systemic (ie, acute renal failure, myocardial infarction, and mortality) complications. Patency and limb salvage were evaluated using Kaplan-Meier life-table analyses and compared using Cox regression analysis. P < .05 was considered statistically significant.
  
  
  RESULTS
  The study comprised 85 patients, 89 limbs, and 114 procedures. Age was 72.4 +/- 13.1 years, 67% were men, and follow-up was 245.8 +/- 290.8 days. The technical success rate for all procedures was 91%. Limb salvage rates for patients with critical limb ischemia at 6, 12 and 18 months were 85% +/- 0%, 81% +/- 0%, and 69% +/- 0%, respectively. For the complete patient cohort, primary patency rates at 6, 12 and 18 months were 68% +/- 6%, 50% +/- 8%, and 37% +/- 9%, respectively, and secondary patency rates were 81% +/- 5%, 71% +/- 7%, and 63% +/- 8%. Multilevel intervention was associated with significantly improved secondary patency compared with single-level intervention (P = .045).
  
  
  CONCLUSIONS
  Patency and limb salvage rates for endovascular treatment of tibial vessel disease in this study are comparable with prior reports and with historical surgical controls. Patients who undergo multilevel intervention involving the tibial vessels exhibit improved secondary patency compared with those who undergo intervention for lesions isolated to the tibial vessels. This may reflect increased distal disease burden for patients who undergo isolated tibial intervention. The study data suggest that the presence of multilevel disease should not preclude an attempt at percutaneous revascularization. Further study is required before formulating definitive recommendations for the endovascular treatment of tibial vessel disease.
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, NY, USA.
authors.forename: Mikel
authors.initials: M
authors.lastname: Sadek
authors.forename: Sharif H
authors.initials: SH
authors.lastname: Ellozy
authors.forename: Irene C
authors.initials: IC
authors.lastname: Turnbull
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lookstein
authors.forename: Michael L
authors.initials: ML
authors.lastname: Marin
authors.forename: Peter L
authors.initials: PL
authors.lastname: Faries
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D017073:Atherectomy; D003452:Cryosurgery; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D015912:Thrombolytic Therapy; D016909:Tibial Arteries / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation