Changing Paradigms in Below-the-Knee Arterial Interventions: Are We Saving Legs?

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Endovascular Therapy

Background:

• Critical limb ischemia (CLI) in below-the-knee (BTK) arteries poses a high risk of limb loss.
• Current endovascular techniques offer potential for limb salvage, but optimal treatment strategies remain debated.

Purpose of the Study:

• To evaluate the effectiveness of an aggressive, multimodality endovascular approach for BTK arterial disease.
• To determine if this approach leads to improved limb salvage rates compared to less aggressive methods.

Main Methods:

• A comparative study analyzed 529 patients with BTK arterial disease treated between 2012-2019.
• Group 1 (2012-2014) received primarily transfemoral angioplasty; Group 2 (2015-2019) underwent a broader range of endovascular modalities.
• The primary endpoint was freedom from amputation at 4 years.

Main Results:

• Group 2 patients received more advanced treatments like pedal angioplasty, retrograde access, and tibial stenting.
• While revascularization of multiple tibial arteries was similar, Group 2 showed a trend towards better outcomes.
• Estimated freedom from amputation at 40 months was significantly higher in Group 2 (63% vs. 53%, P=0.05).

Conclusions:

• An aggressive, multimodality endovascular approach for BTK arterial disease is associated with improved limb salvage.
• These findings support the adoption of comprehensive endovascular strategies for CLI patients.