Short-term outcome of management of isolated complex infrapopliteal disease in critical limb ischemia with drug-coated balloon

Background
However, endovascular intervention provided a great advance in management of peripheral arterial disease, tibial-occlusive disease, especially the complex one, remains a challenging issue regarding not only the management but also the end results even with technical success. In this study, we try to review the outcome of management of cases with complex infrapopliteal disease with drug-coated balloon in patients presented with critical limb ischemia (CLI).
Patients and methods
This is a prospective study of over 50 patients with 50 CLI and isolated tibial-occlusive disease that were managed with angioplasty-first approach with drug-coated balloon in East Jeddah Hospital (Saudi Arabia) in the period from May 2017 to May 2019, with follow-up over 12 months.
Results
The study included 50 patients with a mean age of 64 years and male-to-female ratio 4 : 1, presented with 50 CLI. All patients were classified according to Rutherford classification between category 4 and 6, all lesions were class C and D according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Technical success was accomplished in 40 (80%) limbs, 18 (36%) limbs showed clinical improvement without amputations, 16 (32%) limbs required minor foot amputation, 16 (32%) limbs ended by major amputation, and two cases required distal bypass (popliteal tibial bypass) after failure of the angioplasty-first approach. As regards complications, one case developed acute myocardial infarction after amputation and died in the ICU, five patients developed groin hematoma that was managed conservatively, and primary patency was 100% after 3 months, 86% after 6 months, and dropped to 76% after 12 months for patients with successful revascularization.
Conclusion
Management of complex infrapopliteal disease in CLI is still challenging with an unfavorable outcome. However, using drug-coated balloon in such cases improved the patency rate.