Focal Tibial Endarterectomy for Critical limb ischemia is a valid approach for limb salvage
Daniel E Ramirez, III
UMMC, Ridgeland, MS
INTRODUCTION: Endovascular procedures are becoming overall the most common modality of treatment in peripheral occlusive disease. Despite the overall limb salvage rates with open bypass the minimal invasive approach is most favored due to minimum to no down time in recovery. Our two cases show that endovascular combined with open surgery is a valid option for limb salvage for Critical limb ischemia patients with tissue loss. METHODS: We successfully treated two patient with superficial femoral occlusions with endovascular intervention, but failed to open tibial occlusions percutaneously. The tibial occlusions were heavily calcified and chronically occluded.
RESULTS: Patients subsequently underwent tibial endarterectomy one of the tibio-peroneal trunk and the other of the dorsalis pedis artery. Image 1. Demonstrates the Pulse volume recording waveforms before endovascular intervention, after superficial femoral artery revascularization and final PVR waveform after right pedal artery endarterectomy. Image 2. Shows before and after endarterectomy of the right dorsalis pedis artery. Conclusion: This technique is a valid option with failed endovascular attempt for limb salvage, with less hospital stay compared to bypass. Open surgical technique for limb salvage have overall have better long term results and better limb salvage rates with lower overall incidence of major amputation.
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