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Home > Vascular Annual Meeting^® > RR17. Predictors of Failure and Success of Tibial Interventions...

RR17. Predictors of Failure and Success of Tibial Interventions for Critical Limb Ischemia

Nathanial Fernandez, Ryan McEnaney, Luke Marone, Robert Rhee, Steven Leers, Michel Makaroun, Rabih Chaer
University of Pittsburgh Medical Center, Pittsburgh, PA

OBJECTIVES: The efficacy of tibial artery endovascular intervention (TAEI) for critical limb ischemia (CLI) and particularly wound healing remains to be fully determined.

METHODS: All TAEIs for tissue loss or rest pain (Rutherford 4/5/6) from 2004-2008 were reviewed. Clinical outcomes and patency rates were analyzed by multivariable Cox proportional hazards regression and life table analysis.

RESULTS: 123 limbs in 111 patients (62% male, mean age 74) underwent TAEI. 102 limbs (83%) had tissue loss. All interventions included tibial angioplasty (PTA) with selective atherectomy (17 %); 20% of limbs underwent interventions on >1 tibial vessel. 50 limbs (41%) underwent isolated tibial procedures while 73 had concurrent ipsilateral SFA or popliteal intervention. The mean distal popliteal and tibial runoff score improved from 11.8±3.6 to 6.7±1.6 and the mean ABI increased from 0.61±0.26 to 0.85±0.22. 5 patients (4%) required bypass. One-year primary, primary-assisted and secondary patency rates were 33%, 50% and 56% respectively. Limb salvage rate at one-year was 75% (table). TAEI in an isolated peroneal artery (OR 7.80, p=0.01) was associated with impaired wound healing, whereas multilevel intervention (HR=2.1, p=0.009) and tibial laser atherectomy (HR=3.1, P=0.01) were predictors of wound healing. In patients with tissue loss, 41% achieved complete closure (mean time to healing 10.7±7.4 months) and 39% improved (mean FU 4.4±4.8 months) at last follow up. Diabetes, smoking, statin therapy, and revascularization of >1 tibial had no impact on limb salvage or wound healing. Re-intervention rate was 50% at 1 year (Table 1) and was unaffected by prior atherectomy.

CONCLUSIONS: TAEI is an effective treatment for CLI with acceptable limb salvage and wound healing. Multiple tibial vessel revascularization has no impact on limb salvage but debulking is associated with improved wound healing. Patients with renal failure, pedal disease or isolated peroneal runoff have poor results with TAEI and should be considered for pedal bypass.

AUTHOR DISCLOSURES: N. Fernandez, None; R. McEnaney, None; L. Marone, None; R. Rhee, None; S. Leers, None; M. Makaroun, None; R. Chaer, None.

Table 1.