Percutaneous transluminal angioplasty of tibial arteries for limb salvage in the high-risk diabetic patient.

Abstract

Recent advances in balloon catheter technology allow percutaneous transluminal angioplasty (PTA) of small arteries such as the tibial arteries. PTA can thus be used to treat lower limb ischemia in diabetic patients whose arterial occlusive disease is often localized to the tibial arteries. This series included 14 consecutive diabetic patients who underwent tibial PTA for treatment of limb-threatening ischemia from 1986 to 1992. PTA was selected over conventional bypass procedures because of a lack of autogenous conduit or because of an unacceptably high surgical risk. Limb loss was imminent without prompt improvement in foot perfusion in all patients. Mean follow-up of 17 months demonstrated long-term limb salvage in 10/13 (77%) and "late" cardiac-related death in 3/13 (23%). This series demonstrates that although conventional arterial bypass should routinely supersede angioplasty procedures, tibial PTA offers the opportunity for limb salvage in diabetic patients with inadequate autogenous conduit for distal tibial bypass and may serve as an option for those who are considered too high risk for conventional bypass. Morbidity and mortality rates of tibial PTA parallel those of major amputation in this population with the obvious benefit of achieving limb salvage in carefully selected diabetic patients.