Society For Clinical Vascular Surgery

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Results of Drug Eluting Stents in Tibial Artery PTA
Kristyn Mannoia, MD1, Dennis Gable, MD1, Ogheneyole Odharo2, William P. Shutze, Sr., MD1.
1The Heart Hospital Baylor Plano, Plano, TX, USA, 2Texas Vascular Associates, Plano, TX, USA.

Tibial artery stent angioplasty is being performed increasingly. There is no approved drug eluting stent (DES) for the infra geniculate vessels and the use of DES for tibial arteries has not been well studied for immediate success, patency, target lesion revascularization and subsequent amputation incidence.
We prospectively identified patients in our practice who had a DES placed during tibial artery angioplasty from 2011-2017. Clinical and procedural data was retrospectively extracted from office and hospital records. The arteriograms of the procedure were reviewed and TASC grades assigned to the lesions. Patency was determined by duplex ultrasonography and/or angiography during the follow-up period.
21 patients were treated: 16 males and 5 females with an average age of 71, (range 54 85). Indications were Rutherford class three or above and two thirds had ulceration or gangrene. Comorbidities consisted of hypertension 76%, diabetes 67%, heart disease 71%, and tobacco use 57%. 34 DES were placed. One, two and three lesions were treated in 13, 5 and 3 patients, respectively, with two patients being treated for single lesions at two distinct encounters. The treated arteries were comprised of TASC lesions A (1), B (3), C (11) and D (8) lesions in the anterior tibial artery (11), posterior tibial artery (13), peroneal artery (6), and tibioperoneal trunk (4). The average stent diameter was 3.1 (range 2.5-4mm) with an average length of 18.8 (range 9-32). Immediate success was 100%. Post DES medication treatment was SAPT in 8, DAPT in 7, SAPT + warfarin in 5 and warfarin alone in 1. Mean follow-up was 24.8 months (range 0-76). 2 patients died, both more than a year after stent placement. 2 DES occluded during followup. Target lesion revascularization occurred in 2 lesions, and both remained patent on 6 month followup angiogram. The median DES patency was 31 months (range of 3-76). Two patients required an amputation post DES.
DES angioplasty in the tibial arteries has excellent immediate patency with acceptable long term patency and has potential to be a valuable tool for limb salvage. Further study of the use of DES for tibial artery angioplasty is needed to determine if the commercial development of DES for the infra-geniculate arteries should be encouraged.

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