The Role of Single Tibial Endovascular Revascularization on Limb Salvage of Critical Limb Ischemia

Document Type : Original Article

Authors

1 Department of Vascular Surgery, Faculty of Medicine, Port Said University, Port Said, Egypt

2 Department of Public Health and Preventive Medicine, Faculty of Medicine, Suez Canal University, Suez Canal, Egypt

Abstract

Background: Critical limb ischemia (CLI) is a leading cause of morbidity resulting in elevation of amputation and mortality rate. A significant proportion of CLI patients, presented with infrapopliteal occlusive disease (IPOD). Endovascular therapy (EVT) has been displayed as paralleled to open surgery. Single tibial revascularization has always been controversial, in patients with tissue loss due to the formation of in-line blood flow to the foot. The purpose of this research was to assess the effect of revascularization of a single tibial artery on foot circulation to determine its efficacy in the treatment of CLI with IPOD in all cases of (infra-popliteal) IP stenosis or occlusion with complicated multiple arterial revascularizations. Patients and Methods: This pilot clinical trial was conducted on 72 limbs in 68 patients, who presented with CLI with IPOD lesions with or without tissue loss (Rutherford 5, 6), with greater than 70% stenosis or complete blockage of tibial arteries. Cases were classified into three groupsaccording to the site of affection: anterior tibial artery (ATA) (n=30), posterior tibial artery (PTA)(n=23), and peroneal artery (n=19). Follow-up was according to the clinical limb condition by evaluation of the foot's vascularity. Results: 30 (41.6%) patients had ATA vessel runoff, whereas 23(31.94%) had PTA runoff and19 (26.39%) had peroneal artery runoff. There was an insignificant difference among the groups regarding stenosis and occlusion. Rates of patency were significantly different among the 3 groups until 12 m following the intervention. Technical success and limb salvage rate and mortality were comparable among the three groups. Regarding occlusion and stenosis, technical success was insignificantly different between the stenosis and occlusion group (p < /em> = 0.475). Limb salvage rate elevated significantly in the stenosis group than occlusion group with (HR= 2.4091(95%CI) 1.1411 to 5.0861) (p < /em> = 0.021). Primary patency was significantly advanced in the stenosis group than in the occlusion group with (HR= 7.0918 (95%CI)3.1827 to 15.8021) (p < /em> < 0.0001) while secondary patency was significantly lower in the stenosis group compared to occlusion group with (HR=0.3714 (95%CI) 0.1776 to 0.7765) (p < /em> =0.008). Conclusions: Single tibial artery management resulted in appropriate rates of limb salvage and technical success in CLI patients with compromised tibial outflow. Success rate, improvement of symptoms, and preservation of limb salvage rate, higher 1ry patency incidence was shown with ATA and PTA compared to the peroneal artery and with stenosis compared to occluded arteries.
 

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