Revascularization of multiple tibial arteries is not associated with improved limb salvage.

Abstract Objectives To determine the benefit of performing multiple tibial artery revascularization compared to a single vessel revascularization on patients suffering from chronic limb-threatening ischemia (CLTI). Methods A single center, retrospective cohort study including all patients suffering from CLTI treated with below the knee (BTK( endovascular interventions from 2012 to 2019. Group 1 contained patients who underwent single tibial artery revascularization. Group 2 contained patients who underwent multiple (2 or more) tibial artery revascularizations. More proximal disease, if present, was treated in addition to the tibial disease. Primary endpoint was freedom from amputation. Secondary endpoints included reintervention rates and all-cause mortality. Results A total of 527 limbs in 470 patients with CLTI (non-healing ulcers- 62%, gangrene- 33% and ischemic rest pain- 5%) were included in the study; 245 (46%) limbs underwent one vessel revascularization and 282 (54%) underwent multiple vessel revascularization. The mean follow up was 19±18 months. There was no difference in freedom from amputation between the two groups (68% vs. 63%, P=0.109). On multivariable analysis, factors associated with amputation included dialysis (OR 1.68, CI 1.16-2.45), dyslipidemia (OR 1.37, CI 0.96-1.94) and gangrene (OR 2.08, CI 1.50-2.98). There was no difference in the reintervention rates between the two groups (21.2% vs. 16.7%; P=0.13). The overall survival rate was 73% in both study groups. Conclusion This large, single center study demonstrates that multiple BTK vessel revascularization is not associated with improved limb salvage compared to single vessel revascularization.