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WASHINGTON -- Below-ankle interventions were largely successful for limb salvage among patients with critical limb ischemia (CLI), a single-center study suggested.

Thirty-three patients had below-ankle interventions for severe Rutherford class 5 or 6 disease (mean age 65.4, 67% men) at a Chicago hospital from 2012 to 2016. Half had concomitant interventions in the anterior tibial and posterior tibial arteries; only two and three out of the group had interventions in the superficial femoral/popliteal and peroneal arteries, respectively, reported , of Rush University Medical Center, and colleagues.

Technical success reached 97% for these , Ozen said in a presentation at the Society of Interventional Radiology meeting. The limb salvage rate, or proportion of preserved ankle joints, was also 97%, she added.

Over a mean follow-up of 13 months, there were 11 amputations: seven toes, three metatarsal, and one below-the-knee (BTK) occurring 4 months after revascularization. All minor amputations were planned before the lower extremity arterial revascularizations, she said.

"I am very surprised ... not by the fact that there are technical methods of revascularizing 'small artery disease,' as the technologies and techniques have dramatically improved. I am surprised that of 33 patients with limb-threatening ischemia, all of whom had pedal artery intervention, only 18 also had more proximal artery revascularization, and that limb salvage rates were almost 100%," commented , of Newton-Wellesley Hospital, Mass., who was not part of the study.

Jaff told MedPage Today that it was "very impressive" that only one amputation was BTK.

"As CLI teams continue to form, interventionists must learn all basic and advanced limb salvage revascularization techniques. It is hopeful that technologies will continue to improve, and larger cohorts of patients are followed prospectively to determine the role of pedal artery interventions in CLI," he suggested.

, of Greenville Health System, S.C., told MedPage Today that more high-quality data are needed.

"The objective 'study' of these interventions will be challenging, and will need to include angiographic, hemodynamic, and clinical outcomes," said Gray, who was not involved in the study told MedPage Today. "There is no doubt that intervention on inframalleolar arteries has become the latest 'sexy' challenge for interventionists. The technical advancement of slick, flexible wires, low-profile balloons, and operator skills have enabled these advances. This territory is 'out of reach' for traditional bypass surgical options so it truly is different."

He pointed out that the current study findings don't "prove that it is beneficial; it merely supports the preceding statements," adding that "because of these data and others, more interventionists will attempt inframalleolar arterial angioplasty."

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