Use of collateral branches in the treatment of tibial arteries chronic total occlusions (CTOs)

Abstract

It has to be considered that extreme vascular intervention may be technically challenging in diabetic subjects with CLI, because they mostly have infrapopliteal disease, usually characterized by long chronic calcified occlusions of anterior and posterior tibial and peroneal arteries. Due to the complexity of the tibial arteries involvement in diabetes, a variable percentage of tibial arteries CTOs cannot be recanalized using endovascular techniques. The importance of providing direct straight-line flow to the foot in diabetic patients with CLI has already been emphasized by vascular surgeons who observed better outcomes with distal bypass compared to femoral-popliteal graft or profundoplasty. In a variable percentage of cases, collaterals dilation or tibial arteries dilation through collaterals could be an effective alternative in case of tibial arteries occlusions impossible to cross.