Effect of single tibial artery revascularization on microcirculation in the setting of critical limb ischemia.

BACKGROUND: Benefits of 2-dimensional (2D) angiosome-oriented infrapopliteal revascularization remain controversial. The aim of this retrospective study was to clarify the effect of single tibial artery revascularization on the dorsal and plantar microcirculation of critically ischemic limbs based on skin perfusion pressure (SPP).

METHODS AND RESULTS: Fifty-seven interventions that only involved either anterior tibial artery (ATA) or posterior tibial artery (PTA) revascularization were included in this study. SPP was measured on the dorsal side (theoretically ATA perfusion area) and the plantar side (theoretically PTA perfusion area) before and after the procedure. Dorsal and plantar SPP increased significantly, from 33 (IQR 23-40.5) to 52 (IQR 32.5-65) mm Hg (P<0.0001) and 31.6±16.1 to 44.8±19.2 mm Hg (P=0.001) after ATA revascularization, respectively, and from 29.3±14.0 to 42.4±19.7 mm Hg (P=0.003) and 29.3±9.8 to 43.5±15.9 mm Hg (P<0.001) after PTA revascularization, respectively. Both ATA and PTA revascularization were not associated with any significant differences in ΔSPP between the dorsal and the plantar regions of the foot. Only 64% and 58% of ATA revascularization cases showed higher post-SPP and ΔSPP on the dorsal side than on the plantar side, respectively. Also, only 47% and 40% of PTA revascularization cases showed higher post-SPP and ΔSPP on the plantar side than on the dorsal side, respectively.

CONCLUSIONS: Single tibial artery revascularization, whether of the ATA or PTA, yielded comparable improvements in microcirculation of the dorsal and plantar foot. Approximately half of the feet revascularized had a change in microcirculation that was not consistent with the 2D angiosome theory.