title: Retrograde transdorsal-to-plantar or transplantar-to-dorsal intraluminal re-entry following unsuccessful subintimal angioplasty for below-the-ankle arterial occlusion.
abstract: OBJECTIVE
  To assess the technical feasibility and efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) intraluminal re-entry following unsuccessful subintimal angioplasty for arterial occlusion below the ankle.
  
  
  METHODS
  TDP or TPD retrograde intraluminal re-entry angioplasty was attempted in 8 limbs of 8 diabetic patients (5 men; mean age 74.5 ± 7.76 years, range 62-81) with chronic below-the-ankle arterial occlusive disease when standard transtibial subintimal angioplasty failed. The clinical symptoms, dorsal or plantar arterial pulse volume scores, and ankle-brachial indexes (ABI) were compared before and after the procedures. At follow-up, pain relief, wound healing, limb salvage, and the presence of any restenosis of the target vessels were evaluated.
  
  
  RESULTS
  TDP or TPD retrograde intraluminal re-entry angioplasty was performed successfully in 5 (62.5%) patients; foot pain improved, with median pulse volume scores and ankle-brachial indexes increasing from 0.60 ± 0.55 and 0.32 ± 0.20 before to 2.40 ± 0.55 and 0.75 ± 0.12, respectively, after the procedure (p<0.01 for both). At the end of follow-up, the visual analogue scale improved from 7.40 ± 1.14 to 2.20 ± 1.48 (p=0.002). Ulcers in 2 of the successfully treated patients either healed (n=1) or improved (n=1). No amputation occurred. Restenosis of 1 target vessel was revealed by magnetic resonance angiography.
  
  
  CONCLUSIONS
  TDP and TPD retrograde intraluminal re-entry techniques are feasible and effective in the treatment of foot ischemia in diabetic patients when standard below-the-ankle angioplasty has failed.
authors.affiliation: Department of Radiology, The Sixth Affiliated People’s Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Yue-Qi
authors.initials: YQ
authors.lastname: Zhu
authors.forename: Jun-Gong
authors.initials: JG
authors.lastname: Zhao
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Li
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.forename: Jian-Bo
authors.initials: JB
authors.lastname: Wang
authors.forename: Ying-Sheng
authors.initials: YS
authors.lastname: Cheng
authors.forename: Jue
authors.initials: J
authors.lastname: Wang
authors.forename: Jie
authors.initials: J
authors.lastname: Li
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects; D000842:Ankle / Q000098:blood supply*; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002681:China; D003251:Constriction, Pathologic; D017719:Diabetic Foot / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D023821:Limb Salvage; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014945:Wound Healing