IMAJ | volume 23
Journal 1, January 2021
pages: 28-32
Summary
Background:
Patients with critical limb ischemia (CLI) involving the below-the-knee (BTK) arteries are at increased risk of limb loss. Despite improvement in endovascular modalities, it is still unclear whether an aggressive approach results in improved limb salvage.
Objectives:
To assess whether an aggressive approach to BTK arterial disease results in improved limb salvage.
Methods:
A comparative study of two groups was conducted. Group 1 included patients treated between 2012 and 2014, primarily with transfemoral angioplasty of the tibial arteries. Group 2 included patients treated between 2015–2019 with a wide array of endovascular modalities (stents, multiple tibial artery and pedal angioplasty, retrograde access). Primary endpoint was freedom from amputation at 4 years.
Results:
A total of 529 BTK interventions were performed. Mean age was 71 ± 10.6 years, 382 (79%) were male. Patients in group 1 were less likely to be taking clopidogrel (66% vs. 83%,
P < 0.01) and statins (72 % vs. 87%,
P < 0.01). Several therapeutic modalities were used more often in group 2 than in group 1, including pedal angioplasty (24 vs. 43 %,
P = 0.01), tibial and pedal retrograde access (0 vs. 10%,
P = 0.01), and tibial stenting (3% vs. 25%,
P = 0.01). Revascularization of two or more tibial arteries was performed at a higher rate in group 2 (54% vs. 50%,
P = 0.45). Estimated freedom from amputation at 40 months follow-up was higher in group 2 (53% vs. 63%,
P = 0.05).
Conclusions:
An aggressive, multimodality approach in treating BTK arteries results in improved limb salvage.