Original title: Longitudinal outcomes After Tibioperoneal Angioplasty Alone Compared to Tibial Stenting and Atherectomy for Critical Limb ischemia. Reference: Shaun Reynolds et al. Vascular and and Endovascular Surgery 2013 47(7):507-512

The Infrapatellar peripheral vascular disease has increased in recent years, relating to tissue loss and amputation. The therapeutic strategy is not clear, let alone the use of stents or other devices.

This retrospective study analyzed 2080 patients over 65 years who were hospitalized with critical ischemia with atrophic lesions underwent Infrapatellar angioplasty. According to the strategy they were divided into three groups: balloon angioplasty (56.3 %), stenting angioplasty (16.2 %) and angioplasty plus rotational atherectomy (27.5 %). The population characteristics were well balanced with the exception of the increased use of stents in the African American population. The overall complications were similar in the three groups (balloon 13.5 % versus stent 16.4 % versus atherectomy 11.7 %), but in the stent group cardiac complications were most frequent (1.5 % versus 2.1 % versus 0.5 % respectively, p = 0.03) and kidney (5% versus 8% versus 2.6 %, respectively, P = .02). There was no difference in amputation rate between the groups at 30 days, 60 days and one year. Amputation predictors were male gender and diabetes with chronic complications but not strategy used.

In the cost analysis of these strategies, angioplasty with stenting and angioplasty with atherectomy were of course more expensive than balloon angioplasty.

Conclusion

Infrapatellar angioplasty in patients with critical ischemia and tissue loss using stents or atherectomy was not superior, as well as presenting a higher cost , to balloon angioplasty alone. 

Comment

Severe Infrapatellar disease with atrophic lesions has increased and balloon angioplasty is the best treatment option since the surgery has not been shown to be superior in this area as well as presenting increased morbidity and mortality and costs. It is necessary to develop new techniques to improve the results, especially amputation-free survival.

Courtesy Dr Carlos Fava
Interventional Cardiologist
Favaloro Foundation
Argentina

Dr. Carlos Fava para SOLACI.ORG