Background Critical limb ischemia (CLI) is affecting an increasing number of patients, mainly due to an ageing population and the growing number of diabetics. Clinically, CLI is characterized by rest pain, non-healing foot wounds and gangrene, due to insufficient arterial blood supply. Limb preservation should be the goal in patients with diabetic foot due to tibial occlusive disease. As surgery is associated with considerable morbidity and mortality rates, endovascular therapy can offer a valuable alternative. Small-diameter below-the-knee arteries that were previously unamenable to surgical methods,...

From 2009 to 2012 a total of 245 patients with obstructive injury of tibial vassels were treated in our operating unit. A severe atheroma of pedidia artery and/or of the plantar artery associated with obstruction of metatarsal arterial arch was detected in 54 of them. “Loop thechnique “ is an advanced technique used to recanalize tibial vassels, used nowadays in III level pricipals references centers for the tratment of diabetic foot. With this tecnique , we approach stenotic-obtructive lesions of pedidia and plantars artery ,...

A recanalization with angioplasty of pedidia or plantar artery with “loop” technique obtaining at same time retrograde recanalization of plantar or pedidia artery and the restoration of patency of transmetatarsal artery from which digital artery branch out, was performer in 37 cases. In 3 cases we need a double aproach (anterograde-retrograde) due to the presence of abundant vassels wall calcification. In 7 cases we had a technical failure for iatrogenic vassels lesions (2 cases), embolization (1 case) and difficulty of crossing the obstruction (4 cases).

In conclusion, the pedal-plantar loop technique for percutaneous recanalization of below-the-knee arterial disease appears to be a promising new tool in the interventionist’s armamentarium, either on a bailout basis (i.e., in cases when antegrade revascularization fails), or electively (when traditional approaches are deemed infeasible).

Cardiovasc Intervent Radiol. 2013 Jan 29. Endovascular Treatment of Diabetic Foot in a Selected Population of Patients with Below-the-Knee Disease: Is the Angiosome Model Effective? Fossaceca R, Guzzardi G, Cerini P, Cusaro C, Stecco A, Parziale G, Perchinunno M, De Bonis M, Carriero A. Alternative Techniques for Treatment of Complex Below-the Knee Arterial Occlusions in Diabetic Patients With Critical Limb Ischemia Roberto Gandini, Luigi Uccioli, Alessio Spinelli, Costantino Del Giudice, Valerio Da Ros, Tommaso Volpi, Marco Meloni, Giovanni Simonetti Pedal-Plantar Loop Technique for a Challenging...