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Tibioperoneal angioplasty and bypass
R N Baird1, M D Bradley, K P Murphy
1Department of Vascular Surgery, Camden House, Royal Infirmary, Bristol BS2 8LR, Great Britain.
Acta Chirurgica Belgica
|October 4, 2003
Summary
Revascularization of calf arteries for critical limb ischemia is less common than for thigh arteries, especially in diabetics. Surgical bypass remains the standard, while balloon angioplasty has limitations due to calcification and restenosis.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Diabetic Limb Complications
Background:
- Tibio-peroneal artery disease is treated less frequently than proximal arterial disease.
- Critical limb ischemia (CLI) is the primary indication for intervention in these cases.
- Diabetics commonly present with calf artery disease patterns.
Purpose of the Study:
- To compare revascularization techniques for tibio-peroneal artery disease.
- To evaluate the efficacy and limitations of angioplasty versus bypass surgery.
- To assess treatment options for critical limb ischemia predominantly affecting calf arteries.
Main Methods:
- Review of surgical bypass as the established technique.
- Evaluation of balloon dilation, including sub-intimal angioplasty.
- Consideration of patient factors, particularly diabetes and severe calcification.
Main Results:
- Surgical bypass offers well-documented long-term results.
- Balloon angioplasty faces challenges with severe calcification common in diabetics.
- High restenosis rates and lack of long-term patency data limit angioplasty.
Conclusions:
- Surgical bypass remains the gold standard for tibio-peroneal revascularization.
- Angioplasty's effectiveness is compromised by calcification and restenosis in diabetic patients.
- Further controlled trials are needed to establish long-term outcomes for angioplasty.