Below-the-knee angioplasty: tibioperoneal vessels, the acute outcome

Conventional balloon angioplasty (PTA) was attempted in 111 patients (60% male; mean age 67 +/- 9 years) with 168 below-the-knee, tibioperoneal vessels (TPV) lesions. The presenting predominant symptoms were claudication in 52 (47%), non-healing ulcer/gangrene in 30 (27%), and rest pain in 29 (26%) of patients. An above-the-knee vessel was dilated before TPV angioplasty in 62 patients (56%). A successful PTA was achieved in 152/168 (90%) TPV: stenoses, 124/125 (99%); occlusions, 28/43 (65%). Complications encountered included contrast-induced renal failure (4%), distal embolization (4%), entry site arterial repair or embolectomy (2%), dissection or occlusion (2%), and groin hematoma (2%). A significant complication (death, emergency bypass surgery, or distal embolization) occurred in only 3 patients (3%); no complications whatsoever were found in 100 patients (90%). At discharge, 106 patients (95%) were clinically improved. A restenosis and/or second PTA procedure occurred in 44/108 patients (40%) (mean time: 9 +/- 6 months) with the presenting predominant symptom being claudication in 38 patients (86%). However, only 36% of patients had lesion recurrence with or without new disease, and 64% showed evidence of disease progression with symptoms. Angiographic and clinical success was achieved in 42 patients undergoing second PTA (96%). These data indicate that balloon angioplasty can be successfully utilized in patients with symptomatic obliterative disease of the tibioperoneal vessels with excellent success, a low risk of complications, and good clinical improvement. PTA of the below-knee vessels should not be restricted to patients in limb salvage situations.