Introduction: Endovascular treatment of below-the knee and below-the-ankle artery disease is challenging, but important for limb salvage in critical limb ischemia. The pedal-plantar loop technique is an endovascular reconstruction of pedal arch. We sought to investigate immediate and late outcomes of below-the knee intervention using pedal-plantar loop technique in patients with critical limb ischemia.
Methods: Baseline, procedural and late clinical outcome data of all consecutive patients with rutherford 4-6 critical limb ischemia due to below-the knee disease in which percutaneous transluminal angioplasty was attempted between February 2009 and February 2017 was retrospectively collected at our center. After collection of data, we selected patients whose pedal arch types were type 2 (68.9%) or type 3 (31.1%). Of total 389 patients, 49 (12.5%) patients were approached with the pedal-plantar loop technique. The primary endpoint was acute success (i.e the composite of technical, angiographic and procedural success). The second end points included amputation-free survival, overall survival and target lesion revascularization free survival.
Results: Over a mean follow-up period of 718.2 ± 626.79 days, there were 31 composite endpoints (4 major amputations, 13 minor amputations, 7 target lesion revascularizations, 3 myocardial infarctions and 4 deaths). Acute success was achieved in 95.9% of patients, no major complications were observed. A 30-day mortality rate amounted 0%. The 1-year major amputation-free survival rate and target lesion revascularization free survival rate were 93.9% and 85.7%, respectively.
Conclusion: Pedal-plantar loop technique was feasible and safe, and provided favorable immediate and late outcomes.