Subintimal angioplasty of tibial vessel occlusions in the treatment of critical limb ischaemia: Mid-term results

Objectives: to evaluate the feasibility and preliminary results at 1 year o f subintimal angioplasty of tibial occlusions in critical limb ischaemia (C LI). Material:from December 1997 to December 1999, we intended to treat 36 patie nts and 40 limbs by subintimal angioplasty of occlusions of tibial vessels. Thirty-one had gangrene or ulceration and nine had rest min. Twenty-seven occlusions were more than 10 cm, 10 were 5 to 10 cm and three were less tha n 5 cm in length. Three patients had an occluded previous ipsilateral bypas s graft. All patients were followed 3 monthly for a median of 10 months by means of clinical and duplex examination. Results: the technical success rate was 78% (31/40). Nine technical failure s were treated by conventional surgery or angioplasty of another diseased t ibial vessel. The clinical success rate tons 68% (27/40). Four below-the-kn ee amputations were performed despite a patent recanalisation. Primary and secondary patency rates at 12 months were 56% (72% without technical failur es). The 12-month limb salvage rate was 81% and survival rate Ic,ns 78%. Th ree of five complications were treated by endovascular procedures. The leng th of occlusion (>10 cm) brit not the location of distal re-entry, the type of vessel re-entry and the presence of diabetes are predictors of technica l success and patency. Conclusions: subintimal angioplasty can be used to treat tibial occlusions in patients with CLI. Technical failure does not preclude conventional surg ery and complications may often be treated by endovascular procedures. Howe ver, the durability of angioplasty is as yet uncertain.