How to Approach Below-the-Ankle Arterial Interventions

Abstract

Critical limb ischemia, also referred to as chronic limb-threatening ischemia, is a major medical problem leading to limb amputations if not managed properly with a multispecialty team. Establishment of sufficient arterial flow to the foot is an integral part of this care. During the past two to three decades, arterial revascularization has become primarily endovascular with open surgical approaches significantly diminished in comparison. As techniques, tools, and experiences of the interventionalist have improved, the ability to recanalize more complex lesions has become more commonplace. We are at an age that even the arteries below the ankle can be accessed for complex interventions and even be recanalized if necessary. This article will discuss common arterial interventions performed below the ankle.

Keywords

pedal vasculature - angioplasty - recanalization - arterial - below the ankle - interventional radiology - peripheral arterial disease

Publikationsverlauf

Artikel online veröffentlicht:
16. Juni 2023

• References

• 1 Criqui MH, Fronek A, Barrett-Connor E, Klauber MR, Gabriel S, Goodman D. The prevalence of peripheral arterial disease in a defined population. Circulation 1985; 71 (03) 510-515
• 2 Rutherford RB, Baker JD, Ernst C. et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997; 26 (03) 517-538
• 3 Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45 (Suppl S ): S5-S67
• 4 Katsanos K, Diamantopoulos A, Spiliopoulos S, Karnabatidis D, Siablis D. Below-the-ankle angioplasty and stenting for limb salvage: anatomical considerations and long-term outcomes. Cardiovasc Intervent Radiol 2013; 36 (04) 926-935
• 5 Faglia E, Clerici G, Clerissi J. et al. Early and five-year amputation and survival rate of diabetic patients with critical limb ischemia: data of a cohort study of 564 patients. Eur J Vasc Endovasc Surg 2006; 32 (05) 484-490
• 6 Abdelhamid MF, Davies RS, Rai S, Hopkins JD, Duddy MJ, Vohra RK. Below-the-ankle angioplasty is a feasible and effective intervention for critical leg ischaemia. Eur J Vasc Endovasc Surg 2010; 39 (06) 762-768
• 7 Huizing E, Schreve MA, de Vries JPM, Ferraresi R, Kum S, Ünlü Ç. Below-the-ankle angioplasty in patients with critical limb ischemia: a systematic review and meta-analysis. J Vasc Interv Radiol 2019; 30 (09) 1361-1368.e2
• 8 Nakama T, Muraishi M, Obunai K, Watanabe H. Efficacy of the novel inner PIERCE technique for severely calcified below-the-knee occlusions in a patient with chronic limb-threatening ischemia. Catheter Cardiovasc Interv 2020; 96 (06) 1317-1322
• 9 Kum S, Huizing E, Samarakoon LB, Lim D, Ünlü Ç, Sato T. The direct extravascular calcium interruption arterial procedure technique for heavily calcified vessels. J Vasc Surg Cases Innov Tech 2020; 6 (03) 369-373
• 10 Manzi M, Palena LM. Treating calf and pedal vessel disease: the extremes of intervention. Semin Intervent Radiol 2014; 31 (04) 313-319
• 11 Manzi M, Palena LM. Retrograde percutaneous transmetatarsal artery access: new approach for extreme revascularization in challenging cases of critical limb ischemia. Cardiovasc Intervent Radiol 2013; 36 (02) 554-557
• 12 Palena LM, Brocco E, Manzi M. The clinical utility of below-the-ankle angioplasty using “transmetatarsal artery access” in complex cases of CLI. Catheter Cardiovasc Interv 2014; 83 (01) 123-129
• 13 Spinosa DJ, Harthun NL, Bissonette EA. et al. Subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) for subintimal recanalization to treat chronic critical limb ischemia. J Vasc Interv Radiol 2005; 16 (01) 37-44