ISOLATED TIBIAL VESSEL DISEASE - TREATMENT OPTIONS AND OUTCOME

Tibial vessel disease is an important cause of limb ischaemia, particu larly in diabetics, Revascularisation by angioplasty and bypass is inc reasingly feasible, The aim of this study was to review treatment and outcome in patients with this patterns of disease, We have performed 2 5 procedures in 20 patients since September, 1989, Six patients (5 dia betic) underwent 9 tibial angioplasties for stenotic lesions causing c ritical ischaemia or short-distance claudication. In 6 procedures ther e was single vessel run-off, Eight angioplasties were radiologically s uccessful with a median increase in ankle-brachial index (ABI) of 0.15 [range: 0.00-0.44] at a median follow-up of 9 months, A further 4 pat ients (3 diabetic) with critical ischaemia underwent popliteal-distal, in-situ vein bypass for tibial occlusions. Distal anastomosis was ont o the dorsalis pedis artery or distal anterior artery, Three grafts re main patent with successful limb salvage and ABI's greater that 1.0, A ngioplasty is also useful for distal disease progression following fem oro-popliteal bypass, Six patients with ''at-risk'' grafts underwent 8 tibial angioplasties for stenotic lesions in distal run-off, Radiolog ically, 6 procedures were successful with a median increase in ABI of 0.21 [range: 0.00-0.38] at a median follow-up of 7 months, There were less favourable results when a ''graft-distal'' bypass performed to sa lvage an occluded femoro-popliteal graft with diseased run-off vessels , Three of 4 grafts reoccluded within 3 months, 2 patients requiring a mputation, We advocate an aggressive policy towards localised distal d isease causing foot ischaemia.