Download PDF
Int J Angiol 2020; 29(03): 175-179
DOI: 10.1055/s-0040-1714662
Review Article

Single versus Multiple Vessel Endovascular Tibial Artery Revascularization for Critical Limb Ischemia: A Review of the Literature

Gautam M. Anand 
1   Department of Vascular Surgery, Northwell Health, Lenox Hill Hospital, New York, New York
,
Allan M. Conway
1   Department of Vascular Surgery, Northwell Health, Lenox Hill Hospital, New York, New York
,
Gary Giangola
1   Department of Vascular Surgery, Northwell Health, Lenox Hill Hospital, New York, New York
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Vascular interventionalists have long debated on whether one or multiple patent tibial arteries (run-off) are necessary to treat critical limb ischemia, including ischemic rest pain and tissue loss. This review article seeks to clarify data surrounding this topic by including literature from retrospective studies, prospective studies, meta-analyses, and randomized controlled trials. Our conclusion is that revascularizing a single tibial artery to the foot is adequate for wound healing.

Keywords

tibial - tibioperoneal angioplasty - stent - lower extremity - endovascular procedure - atherosclerosis - artery


Publication History

Article published online:
30 August 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Raffetto JD, Montgomery JE, Eberhardt RT, LaMorte WW, Menzoian JO. Differences in risk factors for lower extremity arterial occlusive disease. J Am Coll Surg 2005; 201 (06) 918-924
    CrossrefPubMedGoogle Scholar
  • 2 Abularrage CJ, Conrad MF, Haurani MJ. , et al. Long-term outcomes of patients undergoing endovascular infrainguinal interventions with single-vessel peroneal artery runoff. J Vasc Surg 2011; 53 (04) 1007-1013
    CrossrefPubMedGoogle Scholar
  • 3 Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970-2002. JAMA 2005; 294 (10) 1255-1259
    CrossrefPubMedGoogle Scholar
  • 4 Adam DJ, Beard JD, Cleveland T. , et al; BASIL trial participants. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 2005; 366 (9501): 1925-1934
    CrossrefPubMedGoogle Scholar
  • 5 Romiti M, Albers M, Brochado-Neto FC, Durazzo AES, Pereira CAB, De Luccia N. Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg 2008; 47 (05) 975-981
    CrossrefPubMedGoogle Scholar
  • 6 Almasri J, Adusumalli J, Asi N. , et al. A systematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limb-threatening ischemia. J Vasc Surg 2018; 68 (02) 624-633
    CrossrefPubMedGoogle Scholar
  • 7 Ozpak B, Bozok S, Cayir MC. Thirty-six-month outcomes of drug-eluting balloon angioplasty in the infrapopliteal arteries. Vascular 2018; 26 (05) 457-463
    CrossrefPubMedGoogle Scholar
  • 8 Teymen B, Aktürk S. Comparison of drug eluting balloon angioplasty to infrapopliteal artery critical lesions with or without additional pedal artery angioplasty in patients with diabetes mellitus and critical limb ischemia. J Interv Cardiol 2018; 31 (03) 400-406
    CrossrefPubMedGoogle Scholar
  • 9 Spiliopoulos S, Vasiniotis Kamarinos N, Brountzos E. Current evidence of drug-elution therapy for infrapopliteal arterial disease. World J Cardiol 2019; 11 (01) 13-23
    CrossrefPubMedGoogle Scholar
  • 10 Popplewell MA, Davies H, Jarrett H. , et al; BASIL-2 Trial Investigators. Bypass versus angio plasty in severe ischaemia of the leg - 2 (BASIL-2) trial: study protocol for a randomised controlled trial. Trials 2016; 17: 11-11
    CrossrefPubMedGoogle Scholar
  • 11 Mills Sr JL. BEST-CLI trial on the homestretch. J Vasc Surg 2019; 69 (02) 313-314
    CrossrefPubMedGoogle Scholar
  • 12 Hunt BD, Popplewell MA, Davies H. , et al; BASIL-3 Collaborative Group. BAlloon versus stenting in severe ischaemia of the Leg-3 (BASIL-3): study protocol for a randomised controlled trial. Trials 2017; 18 (01) 224
    CrossrefPubMedGoogle Scholar
  • 13 Gray BH, Grant AA, Kalbaugh CA. , et al. The impact of isolated tibial disease on outcomes in the critical limb ischemic population. Ann Vasc Surg 2010; 24 (03) 349-359
    CrossrefPubMedGoogle Scholar
  • 14 Fernandez N, McEnaney R, Marone LK. , et al. Predictors of failure and success of tibial interventions for critical limb ischemia. J Vasc Surg 2010; 52 (04) 834-842
    CrossrefPubMedGoogle Scholar
  • 15 Fernandez N, McEnaney R, Marone LK. , et al. Multilevel versus isolated endovascular tibial interventions for critical limb ischemia. J Vasc Surg 2011; 54 (03) 722-729
    CrossrefPubMedGoogle Scholar
  • 16 Sadek M, Ellozy SH, Turnbull IC, Lookstein RA, Marin ML, Faries PL. Improved outcomes are associated with multilevel endovascular intervention involving the tibial vessels compared with isolated tibial intervention. J Vasc Surg 2009; 49 (03) 638-643 , discussion 643–644
    CrossrefPubMedGoogle Scholar
  • 17 Lyden SP. Techniques and outcomes for endovascular treatment in the tibial arteries. J Vasc Surg 2009; 50 (05) 1219-1223
    CrossrefPubMedGoogle Scholar
  • 18 Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg 2006; 117 (07) , suppl): 261S-293S
    CrossrefPubMedGoogle Scholar
  • 19 Alexandrescu V, Söderström M, Venermo M. Angiosome theory: fact or fiction?. Scand J Surg 2012; 101 (02) 125-131
    CrossrefPubMedGoogle Scholar
  • 20 Kawarada O, Yasuda S, Nishimura K. , et al. Effect of single tibial artery revascularization on microcirculation in the setting of critical limb ischemia. Circ Cardiovasc Interv 2014; 7 (05) 684-691
    CrossrefPubMedGoogle Scholar
  • 21 Tsai FW, Tulsyan N, Jones DN, Abdel-Al N, Castronuovo Jr. JJ, Carter SA. Skin perfusion pressure of the foot is a good substitute for toe pressure in the assessment of limb ischemia. J Vasc Surg 2000; 32 (01) 32-36
    CrossrefPubMedGoogle Scholar
  • 22 Acín F, Varela C, López de Maturana I, de Haro J, Bleda S, Rodriguez-Padilla J. Results of infrapopliteal endovascular procedures performed in diabetic patients with critical limb ischemia and tissue loss from the perspective of an angiosome-oriented revascularization strategy. Int J Vasc Med 2014; 2014: 270539
    PubMedGoogle Scholar
  • 23 Ambler GK, Stimpson AL, Wardle BG. , et al. Infrapopliteal angioplasty using a combined angiosomal reperfusion strategy. PLoS One 2017; 12 (02) e0172023-e0172023
    CrossrefPubMedGoogle Scholar
  • 24 Higashimori A, Iida O, Yamauchi Y. , et al; OLIVE Investigators. Outcomes of One straight-line flow with and without pedal arch in patients with critical limb ischemia. Catheter Cardiovasc Interv 2016; 87 (01) 129-133
    CrossrefPubMedGoogle Scholar
  • 25 Manzi M, Fusaro M, Ceccacci T, Erente G, Dalla Paola L, Brocco E. Clinical results of below-the knee intervention using pedal-plantar loop technique for the revascularization of foot arteries. J Cardiovasc Surg (Torino) 2009; 50 (03) 331-337
    PubMedGoogle Scholar
  • 26 Bunte MC, Shishehbor MH. Angiosome-guided intervention in critical limb ischemia. Interv Cardiol Clin 2017; 6 (02) 271-277
    PubMedGoogle Scholar
  • 27 Valle JA, Prouse AF, Rogers RK. Inframalleolar Intervention for Limb Preservation. Interv Cardiol Clin 2017; 6 (02) 261-270
    PubMedGoogle Scholar
  • 28 de Athayde Soares R, Matielo MF, Brochado Neto FC, Martins Cury MV, Marques RC, Sacilotto R. Number of infrapopliteal arteries undergoing endovascular treatment is not associated with the limb salvage rate in patients with critical limb ischemia. J Vasc Surg 2016; 64 (05) 1344-1350
    CrossrefPubMedGoogle Scholar
  • 29 Harris DG, Koo G, McCrone MP. , et al. Acute kidney injury in critically ill vascular surgery patients is common and associated with increased mortality. Front Surg 2015; 2: 8-8
    CrossrefPubMedGoogle Scholar
  • 30 Lavingia KS, Tran K, Dua A. , et al. Multivessel tibial revascularization does not improve outcomes in patients with critical limb ischemia. J Vasc Surg 2020; 71 (06) 2083-2088
    CrossrefPubMedGoogle Scholar