Percutaneous angioplasty of long tibial occlusions in critical limb ischemia.

BACKGROUND

The aim of this study was to assess the midterm results of percutaneous angioplasty in patients with critical limb ischemia (CLI) and long tibial occlusions.

METHODS

Between January and September 2011, 34 consecutive patients with patent femoropopliteal artery and 49 segmental tibial occlusions >8 cm were included in our prospective, single-center cohort study. Clinical success (defined as wound healing and survival without major amputation), patency, and freedom from target vessel revascularization (TVR) were examined.

RESULTS

The median age of the patients was 75 (53-89) years, 74% were diabetic, and 89% of the limbs studied were Rutherford 5 and 6. Median follow-up was 12.5 (1-15) months. The 1-year clinical success rate was 65%, higher among patients with technical success (76% vs. 25%, P = 0.01) and patients with 2 or 3 patent tibial arteries after the procedure (90% vs. 41% in patients with only 1 patent artery, P = 0.003). At 1 year, primary and secondary patency rates were 13% and 32%, respectively (24% and 58% without technical failures). The 1-year freedom-from-TVR rate was 34%.

CONCLUSIONS

Despite high technical failure rates and the need for repeat procedures, percutaneous angioplasty of long tibial occlusions enhances wound healing, especially when integrated into a maximal revascularization approach.