Tibial angioplasty in diabetic patients: should all vessels be treated?

AIM Patients with severe critical limb ischemia (CLI) due to tibial disease are commonly treated nowadays with tibial angioplasty. However, the benefits and complications of treating than one tibial have not yet been determined. This study compares the outcome of angioplasty of one vessel versus that of more than one vessel in patients with CLI due to tibial disease. METHODS We retrospectively reviewed all consecutive diabetic patients with tibial disease with no concomitant proximal lesions who were treated by angioplasty. Among 82 patients with isolated tibial disease 48 patients were selected. All patients had to have more than one diseased tibial vessel that can be treated by angioplasty. Group A patients (N.=25) had only one tibial vessel treated while group B patients (N.=23) had more than one tibial vessel treated. We compared both groups with respect to patients' characteristics, lesion morphology, and limb salvage rate. RESULTS Lesion morphology was worse in group A than B: anterior tibial artery showed more long lesions (17 vs. 8), more multiple lesions (22 vs. 11), and peroneal artery showed more long lesions (23 vs. 10), more multiple lesions (24 vs. 12), and more occlusions (18 vs. 10). Limb salvage rate at 12 months was similar (91%) in both groups. There were 5 complications in each group. CONCLUSION The lesion morphology was worse in group A. Simpler lesions in group B motivated performing more than one vessel angioplasty. There was no difference in the limb salvage rate in the medium term among both groups. Additional vessels angioplasty in less diseased arteries was not associated with substantial additional morbidity.