Angiographic criteria for successful tibial arterial reconstructions

Sixty patients who had tibial arterial occlusions and were threatened with limb loss underwent extended angiographic studies to delineate the calf and pedal circulation. Of these, 36 were diabetic. Ischemic reactive hyperemia induced prior to the injection of contrast medium helped to delineate these vessels clearly. Forty-four had reconstructions to tibial arteries to midcalf, sixteen had reconstructions to a tibial artery at ankle level. Only autologous tissue was employed in vein bypass or endarterectomy procedures. Intraoperative angiographic studies were done in all. Thirty percent required immediate reintervention to recorrect mechanical imperfections in the reconstruction. Cumulative patencies were 84.1 percent for the midcalf and 81.2 percent for ankle reconstructions at one month, but they were 50.3 percent and 39.5 percent, respectively, at two years. Early patency and relief of ischemia correlated with angiographic visualization of the pedal circulation as pedal arches. Late closures were frequently due to intimal or neointimal fibroplasia and could not be predicted from the preoperative angiographic studies. It was concluded that extended angiographic studies using ischemic reactive hyperemia were essential in performing predictable arterial reconstructions to calf and ankle vessels. Reconstructions to midcalf arteries seemed to have a higher late patency rate than ankle reconstructions.