Long-term results: tibial angioplasty in critical limb ischemia

Patients with CLI are typically elderly with multiple co-morbidity and limited life expectancy and therefore, a procedure, which is minimally invasive with reduced morbidity and mortality but lesser long-term patency, may be more appropriate than a more invasive procedure with better long-term patency. This study was conducted to assess the outcome of endovascular angioplasty in treating infragenicular arterial disease in Egyptian diabetic patients with critical limb ischemia. Forty nine patients with [51] limbs presented with critical limb ischemia were subjected to endovascular tibial angioplasty, of which 40 patients had gangrene, 6 patients had ischemic ulcers, 3 had rest pain and 2 with severe foot infections. Overall, 79 arteries of the infra-popliteal [7] and iliac [1] were associated. Technical success was evaluated on angiography at the end of the procedure revascularization of at least one of 3 leg vessels with re-establishment of arterial flow to the foot was regarding technical success. The technical success rate of angioplasty in the revascularization of infra-popliteal vessles was 92%. In the 4 [8%] patients with a technical failure, two patients were treated conservatively and two patients were lost to follow up during the study. The clinical success rate was [80%], healing of an ulcer or wound after minor amputation. The cumulative limb salvage rate quantified by Kaplan-Meier life table analysis was at 20 month 80%. The per-cutaneous tibial angioplasty of infra-popliteal artery stenoses and occlusions is considered as an effective and safe therapy modality to avoid below the-knee amputation in patients with limb threatening ischemia

Long term results of distal tibial bypass in Egyptian patients

The anatomical distribution of atherosclerotic disease is influenced by race. Severe tibial artery disease is common in Middle East patients. We reviewed the results of bypass to the distal tibial arteries in Egyptian patients, known for severe tibial artery disease, performed during the past 6 years, to assess the immediate results and the durability of this procedure. Data of patients who had bypass terminating at the level of the distal tibial arteries during the past 6 years was retrieved from a prospectively collected computer data base, and analyzed. Eighty five patients had bypass to the distal tibial arteries performed by a single surgeon during the period from January 1997 to December 2002, 78% were men, and the mean age was 63 years [24-81]. All 85 patients presented with manifestation of critical ischemia. All bypass procedures were performed using autogenous vein. Three patients died within 30 days [3.5%]. Twelve grafts failed within 30 days, 4 were successfully revised. Primary and assisted primary patency at 36 months was 68% and 78% respectively. Limb salvage at 36 months was 85%, and survival was 62%. Bypass to the distal tibial arteries in Egyptian patients, known for severe tibial artery disease, yields good short terms results, and is a durable procedure with a high long term limb salvage rate

Variation of lower extremity venous function in normal individuals

The change in venous function during the course of the day was studied non-invasively in 50 normal lower extremities of 25 physically active normal subjects. Venous refilling time, measured by photoplethysmography, was significantly shorter [p < 0.0001], and venous capacitance, measured by impedance plethysmography, was significantly reduced [p < 0.04] after 5 hours or more of daily activities performed in the upright position. Abnormally short venous refilling time [less than 18 seconds] developed in 21% of the extremities, which had a normal venous refilling time earlier in the same day. Lower extremity symptoms of ache, pain, or swelling were reported more frequently in extremities that developed an abnormal venous refilling time. There was a trend toward. a greater change in venous refilling time during the day in symptomatic lower extremities than in asymptomatic limbs [p = 0.07]

Duplex detected ankle Doppler velocity for the assessment of degree of peripheral ischemia

Objective: Ankle brachial index [ABI] is widely accepted for the assessment of the degree of peripheral ischemia. Duplex scan is widely used for the investigation of peripheral ischemia. Velocities are routinely measured during Duplex scan. The purpose of this study is to determine whether peak systolic velocity [PSV] of the distal tibial arteries correlates with ABI. and therefore could be used as an alternative method for the assessment of the degree of peripheral ischemia

Material and Methods: Data was prospectively collected for 20 ischemic limbs and 5 healthy volunteers. The age, gender, risk factors, duplex findings, and ABI were recorded for each patient. Duplex PSV was assessed at the most distal segment of the anterior and posterior tibial arteries. Three readings were recorded for each artery, their mean was calculated. ABI was calculated for the anterior tibial and posterior tibial arteries. A mean ABI for both tibial arteries was also calculated. Mean PSV of the anterior tibial artery was correlated with its ABI, mean PSV of the posterior tibial artery was correlated with its ABI, and mean PSV of both tibial arteries was correlated with the mean ABI of both tibial arteries

Results: PSV of the anterior tibial artery correlated well with anterior tibial ABI [r=0.8], PSV of the posterior tibial artery correlated well with posterior tibial ABI [r=0.8], and mean PSV of both tibial arteries correlated well with the mean ABI of both tibial arteries [r=0.8]. in addition 10% of patients with severe ischemia [ABI=<0.4] had mean PSV =<25, and 20% of patients with moderate ischemia [ABI =0.4 to 07] had PSV ranging from 25 to 50, and 20% of patients with mild ischemia [ABI 0.7 to 1.0] had PSV=> 50, while 45% of healthy volunteers with no ischemia [ABI => 1.0] had PSV =>75

Conclusion: These results suggest that PSV measurements at the distal tibial arteries correlate well with ABI measurements. PSV measurements can be used to assess the degree of ischemia, in particular in patients where ABI is falsely elevated due to vessel wall calcification- Dear Wassila Please complete the data in the results section, and include the P value for the correlation ratios