Tibioperoneal arterial lesions and critical foot ischaemia: Successful management by the use of short vein grafts and percutaneous transluminal angioplasty

Background: In a substantial number of mainly diabetic patients isolated cr ural arterial lesions are found to be the underlying cause for severe ischa emic foot lesions. Without revascularisation, patients with this specific o cclusion pattern will inevitably face major amputation. To attain limb salv age in this setting since the early, eighties short vein grafts were used t o bypass the occluded infrapopliteal arteries. More recently, percutaneous transluminal angioplasty (PTA) was also attempted to avoid limb loss in sel ected patients. Patients and methods: Since May 1986 in 125 patients 130 autologous bypass grafts from the BK-popliteal artery or the proximal tibioperoneal arteries to malleolar vessels were performed in the presence of extended corral arte rial occlusions and critical foot ischaemia (rest pain 3, tissue loss 127). In another series in 89 limbs (rest pain 5, tissue loss 84) of 84 patients PTA was done to treat 168 focal stenoses of > 50% diameter reduction and I I short occlusions in a total of 135 crural arteries. Results: Using life-table analysis, primary and secondary cumulative patenc y rates for short vein grafts with distal graft origin were 90% and 98% at 30 days, 76% and 83% at one year and 46% and 49% at seven years, respective ly The corresponding limb salvage rates amounted to 95%, 80% and 63%. Initi al complete or partial technical success after PTA of crural arteries could be obtained in 93%: The limb salvage rates achieved were 95% at 30 days, 8 2% at one year and 63% at six years. Conclusion: Our results suggest that - depending on the extent of lesions - both short vein grafts as well as PTA are successful complementary treatme nt modalities to avoid limb loss in predominantly diabetic patients with in frapopliteal artery, disease and critical ischaemia.