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Factors Affecting Outcomes Of Percutaneous Tibial Interventios: Mid-Term Results

Omar Araim, Brett Butler, Sunita D Srivastava, Sean P Lyden, Daniel Clair, Matthew J Eagleton.
Cleveland Clinic Foundation, Cleveland, OH.

OBJECTIVES: Percutaneous intervention has become an increasingly common treatment option for patients with peripheral arterial occlusive disease (PAOD), especially for those with limb threatening ischemia and significant medical co-morbidities. The goal of this study was to evaluate the mid-term outcomes of percutaneous transluminal angioplasty (PTA) for the treatment of tibial/peroneal PAOD, and to identify factors that influenced limb salvage and survival rates.

METHODS: Demographics and clinical variables (Table) were assessed in 70 consecutive patients undergoing tibial/peroneal PTA in 77 limbs during 2004. Limb salvage and survival rates were calculated using Kaplan-Meier estimates. A Cox proportional hazards model was used to estimate the hazard ratios between levels; significance was set at P<0.05.

RESULTS: Clinical indications for treatment were tissue loss (80%), rest pain (14%), and claudication (6%). The initial technical success rate was 95%. The mean follow-up period was 17.4±1.2 months. During the follow-up period, 6 patients underwent conversion to distal bypass, 7 underwent repeat tibial PTA, and 3 underwent PTA at a more proximal site. Limb salvage and survival rates at 2 years were 68±7% and 74±8%, respectively. Clinical presentation did not affect outcome. The presence of diabetes adversely affected limb salvage rates (54 v. 93%, P=0.008), as did age, with lower limb salavage rates in those less than 60 years (54%) compared to those 60-75 years (73%, P<0.05) and those >75 years (83%, P<0.01). The incidence of diabetes and renal insufficiency did not vary by age. There was a trend toward lower limb salvage rates in patients on dialysis (36%) compared to those with renal insufficiency (67%) and those with normal renal function (79%), but this did not reach statistical significance. The need for dialysis, however, did adversely affect survival at 2 years (36% v. 90%, P<0.001).

CONCLUSIONS: PTA is a viable treatment option for patients with tibial/peroneal PAOD, with acceptable limb salvage and survival rates. As with bypass procedures, adverse outcomes correlate with the presence of diabetes and renal failure. The explanation of poor limb salvage rates in younger patients is not clear and warrants further investigation.