Tibioperoneal (outflow lesion) angioplasty can be used as primary treatment in 235 patients with critical limb ischemia - Five-year follow-up

Background-In a prospective, nonrandomized, consecutive series of tibiopero neal vessel angioplasty (TPVA), critical limb ischemia (CLI) patients' data were analyzed with regard to immediate and follow-up success. Methods and Results-TPVA was successful in 270 of 284 critically ischemic l imbs (95%), with 167 limbs (59%) requiring dilatation of 333 ipsilateral in flow obstructions to access and successfully dilate 486 of 529 (92%) tibiop eroneal lesions. A clinical success (relief of rest pain or improvement of lower-extremity blood flow) was attained in 270 limbs at risk (95%). Clinic al 5-year follow-up of 215 of 221 successful CLI patients (97%) with 266 su ccessfully revascularized limbs revealed that bypass surgery occurred in 8% and significant amputations in 9% of limbs; 91% of the limbs were salvaged . The cohort's probability of survival was 56%: 58% for Fontaine class III and 33% for class IV patients. Class III compared with class IV patients ha d significantly (P <0.05) fewer surgical bypasses (3% versus 16%) and amput ations: above-knee, 1% versus 4%; below-knee, 3% versus 12%; and transmetat arsal, <1% versus 21%. Conclusions-TPVA, often in combination with inflow lesions, is an effective primary treatment for critical limb ischemia. The poor cumulative survival reflects the existence of severe comorbidities, which could potentially be affected by aggressive and effective cardiovascular diagnostic and therape utic strategies.