Affect of the “Tibial-arterial disease” on the outcomes in leg vascular disease patients

The lower limb arterial system is divided in to 3 segments for better understanding of the disease and also for planning various therapeutic options. Aorto-iliac, Femoro-popliteal and Tibio-peroneal diseases are three zones. However the quantity of the disease is not measured accurately for the routine clinical purposes. Therefore comparing the out comes of procedures performed on patients with different degrees of functionally active and mechanical disease. The failure rates of infra popliteal revascularization are high across all the countries irrespective of their methods of revascularization.The determining factors seem to be diabetes and history of prior tissue loss or gangrenous changes.In the routine clinical practice it is important to grade the tibial vessel disease which is often missed. In the post operative period one tries to look for the Doppler signals and palpable pulses which may be or may not be good enough for the relief of symptoms over a long period of time.

In a recent paper published -Multivariable analysis demonstrated tobacco use, renal disease, diabetes, and tissue loss are all predictors of patency loss, while only diabetes and tissue loss were associated with greater limb loss. There was no difference in patency rates irrespective of location of Trans Atlantic Inter-Societal Consensus (TASC) classification, vessel treated (femoral vs tibial), or degree of stenosis (occluded vs stenotic). Also, multiple vessels treated in the same patients had no affect on patency. The mean ankle brachial index (ABI) pre-op was 0.57 +/- 0.19, and this increased to 0.81 +/- 0.21 (P < .001) at 30 days post-op. CONCLUSION: Lower extremity atherectomy procedures with the SilverHawk device are safe and effective means in improving symptoms. However, there is decreased durability and significant patency and limb loss over time. Diabetes, renal disease, tobacco use, and tissue loss are all associated with inferior outcomes.

Reference:

Sarac TP et al, J Vasc Surg. 2008 Oct; 48(4):885-90

Midterm outcome predictors for lower extremity atherectomy procedures. Sarc TP et al
Department of Vascular Surgery, The Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.