Kissing Balloon Technique for Infrapopliteal Angioplasty in Patients with Critical Limb Ischemia

Abstract

This study aimed to analyze the technical aspects and follow-up findings regarding patients with critical limb ischemia who underwent the kissing balloon technique (KBT). Thirty patients (34 bifurcations) were enrolled in this retrospective analysis between September 2010 and February 2017. All patients were submitted to infrapopliteal intervention for critical limb ischemia. The KBT is the primary treatment in 3 situations: for cases with >70% stenosis of the main artery located less than 1cm of the bifurcation, occlusion of one branch with greater than 50% stenosis of the contralateral branch, or greater than 50% bilateral stenosis. Stents were considered in cases of recoil greater than 30% or flow-limiting recoil and were used in 7 of the 34 bifurcations (20.5%). Primary patency at 30days, 1year, and 2years was 100%, 68.1%, and 68.1, respectively. Limb salvage rates at 30days, 1year, and 2years were 100%, 86.6%, and 65.0%, respectively. Wound healing rates at 30days, 6months, 1year, and 2years were 7.1%, 34.4%, 44.5%, and 68.7%, respectively. The bifurcations of the V-shape and T-shape groups were compared in terms of wound healing, primary patency, and limb salvage. No differences were observed in wound healing (P=0.268), primary patency (P=0.394), and limb salvage (P=0.755). The KBT is a feasible bifurcation approach for infrapopliteal angioplasties to maintain the patency of both branches after ballooning. The comparison between the anterior tibial artery and tibioperoneal trunk bifurcation and the peroneal artery and posterior tibial artery bifurcation revealed no difference in wound healing, primary patency, and limb salvage.