Outcomes of endovascular recanalization versus autogenous venous bypass for thromboangiitis obliterans patients with critical limb ischemia due to tibioperoneal arterial occlusion

Abstract

ER is a valid strategy for limb salvage in thromboangiitis obliterans patients who are unsuitable for bypass, contributing an acceptable amputation-free survival as high as with AVB, even though it is associated with lower patency rates and a higher rate of reintervention.

Outcome Analysis Following Tibial Angioplasty in Patients With Critical Limb Ischemia- A Single Centre Experience.

“…It wasthus concluded that endovascular approach for tibial artery diseasewas a lower risk alternative to bypass with similar outcomes (5) .Similar study by Kaichung et all compared outcomes of endovascularrevascularisation versus venous bypass for tibioperoneal arterialocclusion and found that the amputation free survival for ER wassimilar to bypass but was associated with lower patency rate andhigher rates of reintervention (6) .Primary stenting is also an evolving option for infrapopliteadisease. It was found to reduce the risk of reinterventionandamputation , better wound healing, compared with plain balloonangioplasty with no negative impact on the mortality rates andRutherford class (7,8) . But issues of cost effectiveness, stent design,bare metal vs drug eluting stent are areas of debate and hencerequires further randomised control trails.…”

Outcomes of endovascular treatment versus bypass surgery for critical limb ischemia in patients with thromboangiitis obliterans

“…All endovascular procedures were performed under local anesthesia as previously published [ 1 ]. For all bypass surgery procedures, the suitability of the inflow and outflow arterial anatomy was initially evaluated by means of CTA and/or DSA.…”

“…Amputation was classified as either major (above the ankle) or minor (below the ankle) [ 1 ]. The graft patency was assessed using imaging studies (DUS or CTA); primary patency was defined as the interval from the initial procedure until the repeat procedure or a major amputation of the index limb, whichever occurred first, and secondary patency was defined as the interval from the initial procedure until the graft occlusion or a major amputation of the index limb, regardless of the number of subsequent procedures.…”

“…Although arterial bypass with autogenous vein is regarded as the ideal management strategy for patients with severe atherosclerosis obliterans (ASO) affecting the crural arteries presenting with symptoms and signs of critical limb ischemia (CLI), it is not always feasible to perform in patients with thromboangiitis obliterans (TAO). TAO frequently involves the small distal arteries of the calf and the foot causing complete obliteration of the vessel lumen, and superficial veins, used as vascular conduits for bypass surgery, may become affected by the disease in the form of phlebitis migrans with consecutive inflammatory changes [ 1 – 3 ]. During the past two decades, the less invasive endovascular procedure has become an alternative approach for the management of ASO due to the advances in devices and has also been attempted more frequently in TAO patients [ 1 ].…”

“…TAO frequently involves the small distal arteries of the calf and the foot causing complete obliteration of the vessel lumen, and superficial veins, used as vascular conduits for bypass surgery, may become affected by the disease in the form of phlebitis migrans with consecutive inflammatory changes [ 1 – 3 ]. During the past two decades, the less invasive endovascular procedure has become an alternative approach for the management of ASO due to the advances in devices and has also been attempted more frequently in TAO patients [ 1 ]. However, unsuccessful endovascular treatment or repeated occlusions after an endovascular procedure are indications for bypass to the pedal or plantar arteries in selected patients.…”