Pedal arch patency, the challenge of critical limb ischemia

Original Title: Outcomes of Straight-Line Flow UIT and Without Pedal Arch in Patients UIT Critical Limb Ischemia. Reference: Akihiro Higashimori, et al. Catheterization and cardiovascular Intervention 2016;87:129-133

Courtesy of Dr. Carlos Fava.

Establishing one straight line flow into a patent pedal arch in critical limb ischemia is a real challenge occasionally achieved.

This study analyzed 137 patients with critical limb ischemia and only one vessel runoff to the foot; pedal arch patency was achieved in 76 patients vs. 61.

Baseline characteristics where similar, except for the presence of wounds, dialysis and heart failure, more frequent in the second group.

At one year, when patency was achieved, patients presented a higher amputation free survival rate (88.2% vs. 65.6%; p<0.01), more limb salvage (98.4% vs. 89.3%; p=0.03) and better healing.

Conclusion
Among patients with CLI where only one vessel runoff can be established to the foot, direct flow into a patent pedal arch is essential to improve their clinical outcomes.

Editorial Comment
Infrapopliteal intervention is complex and pedal arch revascularization takes long hours. We should be patient and aggressive to achieve optimal revascularization standards and reduce amputation rates.

The presence of heart failure, dialysis and wounds have a negative impact on outcomes.

The use of angiosomes to direct infrapopliteal angioplasty may help improve evolution, even though there are studies that do not share this viewpoint due to collateral circulation.

Courtesy of Dr. Carlos Fava.
Interventional Cardiologist
Favaloro Foundation – Buenos Aires

More articles by this author

TCT 2024 | SIRONA: Randomized Study Comparing Sirolimus-Coated vs Paclitaxel-Coated Balloon Angioplasty in Femoropopliteal Disease

This prospective, randomized, multicenter, investigator-initiated non-inferiority study compared the use of sirolimus-coated balloon (MagicTouch) vs paclitaxel-coated balloon in endovascular treatment.  The primary objective was to...

TCT 2024 | PEERLESS: Mechanical Thrombectomy with FlowTriever vs Catheter-Directed Thrombolysis in Intermediate Risk PTE

Pulmonary embolism (PE) continues to be the third cause of cardiovascular mortality. The current clinical guidelines recommend anticoagulation in intermediate risk patients presenting right...

Atherosclerotic Renal Artery Stenosis: To Revascularize or Not

At long term, atherosclerotic renal artery stenosis (RAS) can lead to hypertension, chronic kidney disease, and cardiac failure. Historically, these patients have been referred...

Endovascular Management of Chronic TEPH: Is Coronary Management Extrapolatable in This Scenario?

Chronic thromboembolic pulmonary hypertension (CTEPH) is a condition that causes significant functional limitation. Its surgical treatment, known as pulmonary endarterectomy (PEA), has improved the...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...