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(Circulation. 2001;104:2057.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Tibioperoneal (Outflow Lesion) Angioplasty Can Be Used as Primary Treatment in 235 Patients With Critical Limb Ischemia

Five-Year Follow-Up

Gerald Dorros, MD; Michael R. Jaff, DO; Ari M. Dorros, MD; Lynne M. Mathiak, RN; Thomas He, PhD

From the William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation Ltd, Grafton, Wis, Wilson, Wyo, and Phoenix, Ariz (G.D., A.M.D., L.M.M.); the Heart and Vascular Institute, Morristown, NJ (M.R.J.); and St Luke’s Medical Center, Milwaukee, Wis (T.H.).

Reprint requests to Gerald Dorros, MD, FACC, Dorros-Feuer Foundation, 1331 N 7th St, Suite 215, Phoenix, AZ 85006. E-mail gdorros{at}dorrosfoundation.org

Background— In a prospective, nonrandomized, consecutive series of tibioperoneal vessel angioplasty (TPVA), critical limb ischemia (CLI) patients’ data were analyzed with regard to immediate and follow-up success.

Methods and Results— TPVA was successful in 270 of 284 critically ischemic limbs (95%), with 167 limbs (59%) requiring dilatation of 333 ipsilateral inflow obstructions to access and successfully dilate 486 of 529 (92%) tibioperoneal lesions. A clinical success (relief of rest pain or improvement of lower-extremity blood flow) was attained in 270 limbs at risk (95%). Clinical 5-year follow-up of 215 of 221 successful CLI patients (97%) with 266 successfully revascularized limbs revealed that bypass surgery occurred in 8% and significant amputations in 9% of limbs; 91% of the limbs were salvaged. The cohort’s probability of survival was 56%: 58% for Fontaine class III and 33% for class IV patients. Class III compared with class IV patients had significantly (P<0.05) fewer surgical bypasses (3% versus 16%) and amputations: above-knee, 1% versus 4%; below-knee, 3% versus 12%; and transmetatarsal, <1% versus 21%.

Conclusions— TPVA, often in combination with inflow lesions, is an effective primary treatment for critical limb ischemia. The poor cumulative survival reflects the existence of severe comorbidities, which could potentially be affected by aggressive and effective cardiovascular diagnostic and therapeutic strategies.

Key Words: angioplasty • peripheral vascular disease • surgery • vasculature

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