Percutaneous transluminal angioplasty of the tibial arteries

Abstract

To evaluate the results of percutaneous transluminal angioplasty (PTA) of the tibial vessels, results of 50 procedures performed in 38 patients since 1988 were analysed retrospectively. A total of 73 tibial vessels were treated: 32 anterior tibial arteries, 16 posterior tibial arteries, four peroneal arteries, 12 tibioperoneal trunks and nine trifurcation lesions. Forty-four of 50 PTA procedures were performed in conjunction with interventions in the femoropopliteal arteries and six as isolated procedures. One patient required a femorodistal graft following perforation of the popliteal artery during atherectomy. Distal emboli occurred in two patients and acute thrombosis of both the angioplastied tibial vessels occurred in a third. The technical success rate was 96 per cent. Patients were followed for a mean(s.d.) of 21(13) months. At the latest follow-up, 58 per cent had improved clinically. There were significant improvements in 43 per cent of limb isotope blood flow studies and 52 per cent of ankle:brachial Doppler pressure indices in treated limbs at this time. PTA should be the first treatment option in patients with infrapopliteal arterial disease needing intervention, whenever it is technically feasible.

The Importance of Patency in Patients with Critical Limb Ischemia Undergoing Endovascular Revascularization for Infrapopliteal Arterial Disease

“…Second, a direct comparison of functional clinical outcomes is limited due to substantial variability of clinical end point definitions or the lack of clinical outcome reports at all ( 20 , 33 ). Clinical end point definitions included subjective relief, freedom from CLI, improvement of clinical classification, and limb salvage ( 8 , 32 , 40 , 41 ). Moreover, clinical outcomes were not reported throughout all studies but only in 26/30 (86.7%) studies.…”

Tibioperoneal Angioplasty and Bypass

“…Most reports of tibioperoneal angioplasty are series of patients with critical limb ischaemia (3-6, 11, 14, 16, 21, 25, 29, 31, 33-35, 37, 39, 47) several of which include patients with diabetes (6,14,31,33). Critical limb ischaemia in these patients presented clinically as rest pain, ulcers and gangrene.…”

Iatrogenic vessel perforation during below-the-knee percutaneous revascularisation for critical limb ischaemia: successful management with deep catheter intubation and prolonged balloon inflations

“…potential challenges and complications when facing such lesions. Complications of below-the-knee PTA may range from 6 to 30%, depending on several factors, including lesion characteristics, and the treatment strategy adopted [1,2,4]. This clinical picture emphasizes the challenges concerning both attempt at passing through a long chronic total occlusion of the tibial vessels and the risks of an aggressive wiring approach, which is indeed the only technique for successful revascularisation in similar difficult conditions.…”

“…In this case of iatrogenic vessel perforation with contrast extravasation, it proved critical to safeguard lesion access and limit blood flow through the occlusion by means of deep catheter intubation. Prolonged balloon inflations allowed complete perforation sealing and enabled to achieve good final distal flow without the need for emergency surgery or the occurrence of compartment syndrome, which is actually the most feared complication of lower limb vessel rupture [4]. Vessel perforation may usually be managed conservatively as long as distal flow through Vessel rupture during below-the-knee PTA Fusaro et al 307 As soon as the lesion was crossed, angiography disclosed vessel perforation at the proximal site of the anterior tibial artery ((a), contrast extravasation indicated by the arrow).…”