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Background The aim of this study was to assess the midterm results of percutaneous angioplasty in patients with critical limb ischemia (CLI) and long tibial occlusions. Methods Between January and September 2011, 34 consecutive patients with patent femoropopliteal artery and 49 segmental tibial occlusions >8 cm were included in our prospective, single-center cohort study. Clinical success (defined as wound healing and survival without major amputation), patency, and freedom from target vessel revascularization (TVR) were examined. Results The median age of the patients was 75 (53–89) years, 74% were diabetic, and 89% of the limbs studied were Rutherford 5 and 6. Median follow-up was 12.5 (1–15) months. The 1-year clinical success rate was 65%, higher among patients with technical success (76% vs. 25%, P = 0.01) and patients with 2 or 3 patent tibial arteries after the procedure (90% vs. 41% in patients with only 1 patent artery, P = 0.003). At 1 year, primary and secondary patency rates were 13% and 32%, respectively (24% and 58% without technical failures). The 1-year freedom-from-TVR rate was 34%. Conclusions Despite high technical failure rates and the need for repeat procedures, percutaneous angioplasty of long tibial occlusions enhances wound healing, especially when integrated into a maximal revascularization approach.

Background Subintimal recanalization allows for the treatment of percutaneously extended occlusive lesions. The aim of this study was to evaluate the feasibility and short- and mid-term results of subintimal recanalization in the treatment of femoropopliteal occlusive lesions in patients with critical ischemia. Methods Between January 2009 and December 2010, consecutive patients with critical ischemia presenting with femoropopliteal arterial occlusion were included in this study. These patients underwent subintimal recanalization, and all patients had clinical and ultrasound follow-up. Results Sixty-six procedures were performed on 66 patients (mean age, 79 ± 10 yrs). All patients were American Society of Anesthesiologists classification 3 or 4. Thirty-two patients had diabetes and 27 had chronic renal insufficiency. More than two-thirds (76%) of the lesions had a Trans-Atlantic Inter-Society Classification of C or D. The mean occlusion length was 13.5 ± 7 cm. The rate of technical success was 85%. The peroperative complication rate was 4.5%. There were no cases of operative mortality. Occlusion length was the only predictive factor of restenosis ( P = 0.049). At 1 year, primary and secondary patency rates were 56% and 70%, respectively, for a 92% rate of limb salvage. Conclusion The subintimal recanalization technique is feasible and minimally invasive. At 1 year postprocedure, the primary patency is poor, but this technique is associated with a high rate of limb salvage. It is suitable for the treatment of critical ischemia, taking into account the often precarious clinical backgrounds of these patients.