OBJECTIVE: To evaluate the efficacy of infra-inguinal, primary angioplasty as a method of limb salvage in patients with trophic lesions secondary to critical ischemia. MATERIALS AND METHODS: Thirty-six patients submitted to primary percutaneous transluminal angioplasty without stenting were evaluated. All of them presented critical limb ischemia with trophic lesion (Rutherford grade III, category 5). Eighty-four angioplasties were performed for 17 lesions in superficial femoral artery, 16 lesions in popliteal artery, and 51 lesions in below-knee arteries. Additionally, prevalence in relation to sex, age, limb involved and main comorbidities have been discussed, with technical considerations regarding procedures and materials utilized. RESULTS: Clinical success has been defined as complete healing of the trophic lesion or amputation level limited to toes or forefoot, not requiring bypass surgery, independently from time, drugs utilized and number of debridement procedures performed. CONCLUSION: Femoropopliteal and belowknee angioplasties present high technical success, low mortality and low complications rates and are highly effective in the treatment of patients with critical lower limb ischemia.

Keywords: Balloon angioplasty, Percutaneous transluminal angioplasty, Popliteal artery, Leg arteries, Limb salvage, Lower extremity

The authors report the case of mixed approach for endovascular treatment of occlusive disease of the anterior tibial artery by retrograde pedal artery access where the traditional antegrade approach failed to overcome a segmental occlusion. The technique seems to offer an option for endovascular procedures aimed at treating occlusion of the anterior tibial artery in cases where the conventional antegrade approach demonstrates to be inappropriate.

Keywords: Angioplasty; Arterial occlusive disease; Percutaneous transluminal angioplasty; Tibial arteries; Endovascular procedures.