Retrograde Transdorsal-to-Plantar or Transplantar-to-Dorsal Intraluminal Re-Entry Following Unsuccessful Subintimal Angioplasty for Below-the-Ankle Arterial Occlusion

Abstract

Purpose:

To assess the technical feasibility and efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) intraluminal re-entry following unsuccessful subintimal angioplasty for arterial occlusion below the ankle.

Methods:

TDP or TPD retrograde intraluminal re-entry angioplasty was attempted in 8 limbs of 8 diabetic patients (5 men; mean age 74.5±7.76 years, range 62–81) with chronic below-the-ankle arterial occlusive disease when standard transtibial subintimal angioplasty failed. The clinical symptoms, dorsal or plantar arterial pulse volume scores, and ankle-brachial indexes (ABI) were compared before and after the procedures. At follow-up, pain relief, wound healing, limb salvage, and the presence of any restenosis of the target vessels were evaluated.

Results:

TDP or TPD retrograde intraluminal re-entry angioplasty was performed successfully in 5 (62.5%) patients; foot pain improved, with median pulse volume scores and ankle-brachial indexes increasing from 0.60±0.55 and 0.32±0.20 before to 2.40±0.55 and 0.75±0.12, respectively, after the procedure (p<0.01 for both). At the end of follow-up, the visual analogue scale improved from 7.40±1.14 to 2.20±1.48 (p=0.002). Ulcers in 2 of the successfully treated patients either healed (n = 1) or improved (n = 1). No amputation occurred. Restenosis of 1 target vessel was revealed by magnetic resonance angiography.

Conclusion:

TDP and TPD retrograde intraluminal re-entry techniques are feasible and effective in the treatment of foot ischemia in diabetic patients when standard below-the-ankle angioplasty has failed.