ABSTRACT
The preferred method for revascularization of symptomatic infrapopliteal arterial
occlusive disease (IPAD) has traditionally been open vascular bypass. Endovascular
techniques have been increasingly applied to treat tibial disease with mixed results.
We evaluated the short-term outcome of percutaneous infrapopliteal intervention and
compared the different techniques used. A retrospective analysis of consecutive patients
undergoing endovascular treatment for infrapopliteal arterial occlusive lesions between
2003 and 2007 in a tertiary teaching hospital was performed. Patient demographic data,
indication for intervention, and periprocedural complications were recorded. Periprocedural
and short-term outcomes were measured and compared. Forty-nine infrapopliteal arteries
in 35 patients were treated. Twenty vessels (15 patients) underwent angioplasty and
29 vessels (20 patients) were treated with atherectomy. Demographic and angiographic
characteristics were similar between the groups. Twenty-six patients had concurrent
femoral and/or popliteal artery interventions. Overall, technical success was 90%
and similar between angioplasty and atherectomy groups (85% versus 93%, p = NS). The vessel-specific complication rate was 10% and was similar between both
groups (angioplasty 5% versus atherectomy 14%, p = NS). One dissection occurred in the angioplasty group; one perforation and three
thromboembolic events occurred in the atherectomy group. Limb salvage and freedom
from reintervention at 6 months were 81% and 68%, respectively, and were not significantly
different between the angioplasty and atherectomy groups. Endovascular intervention
for IPAD had acceptable periprocedural and short-term success rates in our high-risk
patient population. Both atherectomy and angioplasty can be used successfully to treat
symptomatic IPAD.
KEYWORDS
Angioplasty - atherectomy - atherosclerosis - infrapopliteal - plaque excision - tibial
- stent
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Alik FarberM.D. F.I.C.A.
Section of Vascular and Endovascular Surgery, Boston University Medical Center
88 East Newton Street, Collamore Building 5th Floor, Boston, MA 02119-2393
eMail: alik.farber@bmc.org