Introduction
The multilevel arterial arteriosclerosis leads to a major loss of blood perfusion to the target tissues with resultant critical limb ischemia.
Aim
The aim of this article is to compare the results between total revascularization of all level arterial lesions versus revascularization of the proximal lesions regarding limb salvage rates, midterm primary patency rates, and secondary patency rates.
Patients and methods
A prospective study conducted on diabetic patients with symptomatic peripheral arterial disease affecting more than one level of lower limb arterial tree, from January 2013 till the end of December 2013, with critical limb ischemia and no previous attempts of revascularization. Follow-up was 1 year.
Results
A total of 101 diabetic patients were included. Their mean age was 64.4±14 years, and 62.4% were males. They were divided into two groups: group F had full revascularization for all diseased arterial levels and group P had revascularization for the proximal lesion only. Lesions were crossed intraluminal in 54 (53.5%) and subintimal in 47 (46.5%). Stents were used in 44 (43.6%). Primary patency rate was higher in group F than in group P (72.3 vs. 33.3%, =0.002). The secondary patency rates were higher in group F compared with group P at 6 months (84 vs. 44%) and at 12 months (78 vs. 38%) (=0.001). Total limb salvage rate was 80.2% and a major amputation rate was 19.8% over a 1-year follow-up period; limb salvage in group F was 88% and in group P was 44% (=0.001).
Conclusion
In diabetic patients with multilevel arterial lesions affecting more than one arterial territory, total correction of all arterial lesions should be done with direct pulsatile flow to the foot as it is associated with better primary and secondary patency rates and higher limb salvage rates than correction of the proximal lesions.