title: Tibioperoneal Occlusive Disease: A Review of below the Knee Endovascular Therapy in Patients with Critical Limb Ischemia.
abstract: BACKGROUND
  Tibioperoneal occlusive disease is one of the most difficult disease processes to successfully treat. Previous studies have attempted to address the outcomes of tibial interventions in this patient population; however, the majority of these study cohorts are composed of patients who have undergone concomitant aortoiliac or femoral procedures. Our objective was to present the outcomes of patients treated with endovascular intervention for isolated below-the-knee atherosclerotic disease causing critical limb ischemia (CLI).
  
  
  METHODS
  We performed a retrospective review of all patients who underwent isolated endovascular treatment of the below-knee popliteal, tibial, and/or peroneal arteries for CLI (Rutherford class 4-6). Primary outcomes include wound healing, reintervention rates, and amputation-free survival out to 5 years, as well as 1-year primary patency rates.
  
  
  RESULTS
  116 patients were identified as having undergone a tibial endovascular intervention. Ninety-two had concomitant aortoiliac or femoropopliteal interventions; after excluding those patients, we identified 24 limbs that were treated for isolated below-knee popliteal, tibial, and/or peroneal occlusive disease using an endovascular modality. 62.5% of limbs had successful wound healing, whereas 37.5% eventually required a major amputation. Mean time to amputation was 514.6 days (standard error: 57.3). Of those patients with successful limb salvage (n = 15), 66.7% required only the index procedure to heal; the remaining 33.3% required a repeat endovascular intervention, an arterial bypass, or a combination to successfully heal. The mean time to reintervention was 780.1 days (standard error: 179.5). The 1-year primary patency rate was 52.6% (n = 19).
  
  
  CONCLUSIONS
  Patients with CLI secondary to isolated below-the-knee atherosclerotic occlusive disease are a difficult population to successfully treat; despite this, these patients benefit from an initial attempt at endovascular limb salvage. In our experience, this approach resulted in a respectable limb salvage rate of 62.5% and did not compromise open surgical solutions in the event of nonhealing.
authors: Department of Surgery, William Beaumont Army Medical Center, El Paso, TX. Electronic address: katbmuir@gmail.com.
authors: Kathryn B
authors: KB
authors: Muir
authors: Department of Surgery, William Beaumont Army Medical Center, El Paso, TX.
authors: Patrick R
authors: PR
authors: Cook
authors: Department of Surgery, William Beaumont Army Medical Center, El Paso, TX.
authors: Maxwell R
authors: MR
authors: Sirkin
authors: Department of Surgery, William Beaumont Army Medical Center, El Paso, TX.
authors: Gilbert
authors: G
authors: Aidinian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D003251:Constriction, Pathologic; D016638:Critical Illness; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014945:Wound Healing