Background: The aim of the study was to assess the potential of endovascular treatment of severe lower leg ischemia and obstructive lesions in below-the-knee arteries (Rutherford class 4-6 or class 3 with a claudication distance below 50 m) in patients deemed not suitable for surgery.
Material and methods: 85 patients who underwent below-the-knee endovascular interventions between February 2005 and November 2006 were included into the study. There were 52 diabetics and 27 patients on chronic hemodialysis. All patients were initially turned down from surgery on the basis of a clinical assessment and a lower leg angiography. Concomitant obstructive above-the-knee lesions were treated at the same sitting (iliac arteries were treated in 4 cases and femoral or popliteal arteries in 85 cases). A good result was diagnosed when restoration of normal flow to the dorsal pedal or plantar arteries directly through dilated or opened tibial arteries was achieved. The result was considered to be moderate when inflow into the pedal arteries was increased in relation to the initial angiography, but achieved thanks to the increased flow within the collaterals of dilated tibial or peroneal arteries. No change or worsening was diagnosed, when flow to the foot did not change or decreased in relation to the initial angiography.
Results: Immediate technical success was achieved in 85 procedures (83%) - this was estimated good in 55 procedures (53.9%) and moderate in 30 (29.4%). No change was seen in 13 procedures (12.7%) while worsening was seen in 4 (4.9%). In 3 patients in whom the initial result was bad, local intraarterial fibrinolysis and ancillary angioplasty were subsequently performed and the final results were deemed good.
Conclusions: Endovascular treatment of patients with advanced leg ischemia who are not suitable for open surgery seems to be justified. Immediate beneficial effects in angiographic assessment can be obtained in most cases.