5-Year Outcomes After Salvage Tibial Angioplasty for Critical Limb Ischaemia

Abstract

Introduction: Distal bypass surgery for critical limb ischaemia (CLI) is technically challenging and risky in the ageing frail population. Data from BASIL trial have shown that endovascular revascularization is a viable option for CLI however long-term outcome studies are lacking. Aims: To evaluate technical success and primary patency rates after salvage tibial angioplasty, mortality and amputation-free survival as well as long term outcome. Methods: A retrospective study included consecutive tibial angioplasties performed from December 2009 to May 2014 at single tertiary center. Disease severity was classified according to Graziani classification from digital subtraction imaging. Primary outcomes were technical success, major and minor amputation rate, patient’s survival and long-term outcome. Results: Sixty two angioplasties were performed in 54 patients (M:F=42:12). The mean age was 70±11 years, 83% diabetics, 50% hypertensives and 64% were current or ex-smokers. Multivessel disease was present in 52% of cases. Overall mean follow-up was 3.96±2.7 years and 6.15±1.5 years amongst patients still alive. Technical success, as defined at ≥ 1 patent vessel with improved completion pedal flow, was achieved in 81%. Wound healing was 69% and was significantly associated with technical success (p<0.001). Five year survival was 49%. Only 16% required major amputations and 46% minor amputations. Patients required re-angioplasty in 9.5%. Chronic kidney disease (CKD) was a strong predictor of poor wound healing and major amputation (p=0.02). Disease severity was not associated with a poorer outcome. Conclusion: Tibial angioplasty is an effective treatment for CLI. Technical success and CKD are predictors of wound healing and major amputation.