Always contact a vascular interventional specialist before amputating a patient with critical limb ischemia.
Patients with severe critical limb ischemia (CLI) due to long tibial artery occlusions are often poor candidates for surgical revascularization and frequently end up with a lower limb amputation. Subintimal angioplasty (SA) offers a minimally invasive alternative for limb salvage in this severely compromised patient population. The objective of this study was to evaluate the results of SA in patients with CLI caused by long tibial occlusions who have no surgical options for revascularization and are facing amputation. We retrospectively reviewed all consecutive patients with CLI due to long tibial occlusions who were scheduled for amputation because they had no surgical options for revascularization and who were treated by SA. A total of 26 procedures in 25 patients (14 males; mean age, 70 +/- 15 [SD] years) were evaluated. Technical success rate was 88% (23/26). There were four complications, which were treated conservatively. Finally, in 10 of 26 limbs, no amputation was needed. A major amputation was needed in 10 limbs (7 below-knee amputations and 3 above-knee amputations). Half of the major amputations took place within 3 months after the procedure. Cumulative freedom of major amputation after 12 months was 59% (SE = 11%). In six limbs, amputation was limited to a minor amputation. Seven patients (28%) died during follow-up. In conclusion, SA of the tibial arteries seem to be a valuable treatment option to prevent major amputation in patients with CLI who are facing amputation due to lack of surgical options.
Met
Rosemarie
R
Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. r.met@amc.uva.nl
Koelemay
Mark J W
MJ
Bipat
Shandra
S
Legemate
Dink A
DA
van Lienden
Krijn P
KP
Reekers
Jim A
JA
D000368:Aged; D000671:Amputation, Surgical; D000792:Angiography; D017130:Angioplasty / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D023821:Limb Salvage; D008297:Male; D015641:Radiography, Interventional; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D016909:Tibial Arteries; D016896:Treatment Outcome
Chest. 1998 Nov;114(5 Suppl):489S-510S
9822059
Eur J Vasc Endovasc Surg. 2007;33 Suppl 1:S1-75
17140820
Arch Surg. 2001 Jun;136(6):635-42
11386999
J Vasc Interv Radiol. 2003 Sep;14(9 Pt 2):S395-404
14514855
Eur J Vasc Endovasc Surg. 2006 Dec;32(6):663-7
16935010
Eur J Vasc Endovasc Surg. 1999 Nov;18(5):401-10
10612642
Ann Surg. 2008 Mar;247(3):411-20
18376183
Lancet. 2005 Dec 3;366(9501):1925-34
16325694
Eur J Vasc Endovasc Surg. 2000 Oct;20(4):358-62
11038148
J Vasc Surg. 1997 Sep;26(3):517-38
9308598
Br J Surg. 2004 Aug;91(8):948-55
15286954
Eur J Vasc Surg. 1991 Oct;5(5):511-6
1720403
Eur J Vasc Endovasc Surg. 1997 Sep;14(3):212-6
9345242
J Vasc Surg. 2006 Jul;44(1):108-114
16828434
Eur J Radiol. 1998 Oct;28(3):192-8
9881251
J Vasc Surg. 2008 Jul;48(1):128-36
18502084
Cardiovasc Intervent Radiol. 2008 Jul-Aug;31(4):687-97
18414946
Eur J Vasc Endovasc Surg. 2000 Nov;20(5):441-6
11112462
J Endovasc Ther. 2002 Aug;9(4):411-6
12223000
Eur J Vasc Endovasc Surg. 2007 Jul;34(1):50-2
17408989
Eur J Vasc Endovasc Surg. 1999 Jun;17(6):480-5
10375483
Lancet. 2002 Aug 10;360(9331):427-35
12241713
Diabetes Care. 2005 Sep;28(9):2155-60
16123483
Eur J Vasc Surg. 1990 Oct;4(5):463-7
1699814
Cardiovasc Intervent Radiol. 2009 Jan;32(1):132-5
18661174