title: Clinical effects of single or double tibial artery revascularization in critical limb ischemia patients with tissue loss.
abstract: OBJECTIVE
  The achievement of single vessel inflow to the wound is an acceptable end point of peripheral vascular intervention for patients with critical limb ischemia (CLI) with tissue loss. However, CLI patients often have multitibial artery lesions. We evaluated the clinical effects of single or double tibial artery revascularization for CLI patients.
  
  
  METHODS
  This study was conducted retrospectively in a single center. Between April 2007 and January 2015, we treated 123 CLI patients (137 limbs) who had lesions in both the anterior tibial artery and the posterior tibial artery. Of these, single tibial artery (anterior or posterior tibial artery) revascularization was performed in 84 limbs (group S) and double tibial artery (both anterior and posterior tibial arteries) revascularization was performed in 53 limbs (group D).
  
  
  RESULTS
  The wound healing rate was significantly higher (87% vs 79%; P = .003), the time to wound healing was shorter (median, 83 vs 142 days; P = .01), and the repeat peripheral vascular intervention rate was lower (15% vs 35%; P = .03) in group D than in group S. The wound healing rate was nearly similar between the 2 groups in patients with a low clinical stage as assessed by Society for Vascular Surgery Wound, Ischemia, and foot Infection (90% in group D vs 93% in group S; P = .20); however, the wound healing rate was significantly higher in group D in patients with a high clinical stage (85% vs 72%; P = .007).
  
  
  CONCLUSIONS
  The achievement of double vessel inflows to the wound by double tibial artery revascularization positively affects wound healing, particularly in severe CLI patients.
authors.affiliation: Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, Kanagawa, Japan. Electronic address: ovation17@gmail.com.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, Kanagawa, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, Kanagawa, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamawaki
authors.affiliation: Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, Kanagawa, Japan.
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.affiliation: Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, Kanagawa, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takimura
authors.affiliation: Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, Kanagawa, Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, Kanagawa, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Mori
authors.affiliation: Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, Kanagawa, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D055109:Ankle Brachial Index; D001783:Blood Flow Velocity; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000628:therapy*; D007564:Japan; D023821:Limb Salvage; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012039:Regional Blood Flow; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014945:Wound Healing