INFRA-POPLITEAL ARTERIAL-OCCLUSION - ENDO VASCULAR TREATMENT

Femoro-tibial bypasses are not always feasible in patients presenting with << critical >> chronic ischemia. The results of endovascular ther apies carried out over a 2-year period are analyzed. Twenty-three pati ents with critical ischemia (rest pain 13%, gangrene 87%) had 25 proce dures on 29 leg arteries: percutaneous transluminal angioplasty in 17 arteries, rotational atherectomy in 10 arteries, laser recanalization (1 artery), directional atherectomy (1 artery). The hospital mortality rate was 4.3%. The cumulative patency and limb salvage rates were res pectively 51% and 77% at 6 months, 34% and 71% at 12 months. Candidate s for tibial-peroneal endovascular techniques should have a threatened limb, as long as the consequences of failed procedures on patients pr esenting with claudication can be disastrous, and as long as midterm p atency rates reported in the literature are not fair enough. In locali zed stenosis or short occlusions with adequate runoff, endovascular te chniques are a good alternative to femorotibial bypasses for limb salv age. In diffuse lesions with no possibility of bypass, endovascular te chniques can facilitate limb salvage, even if the mid-term arterial pa tency rate is poor. When conventional therapies cannot face critical i schemia, endovascular therapies can provide a fair limb salvage rate.