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