How to Achieve the Best Treatment of Tibial Occlusive Disease? Early Experience in Benha University Hospitals

Abstract
Background: The treatment of constructable tibial occlu-sive disease has changed dramatically because of the advent of catheter-based interventions. However, surgical bypass techniques continue to evolve in response to increasingly complex scenarios such as failed endovascular procedures.
Aim of Study: To achieve the best treatment using the endovascular intervention versus distal bypass in constructable tibial occlusive disease.
Patients and Methods: This prospective randomized controlled study was done on 40 patients (60 limbs) assigned into two groups, each group contains 30 limbs. Group A 30 limbs prepared for distal surgical bypass. Group B 30 limbs prepared for endovascular intervention. Follow-up period was for 18 months.
Results: Despite endovascular intervention had equal patency rates at 6th month as distal surgical bypass; 21 limbs (70%), p=1.000. It was much less than surgical bypass in morbidities; in Group A 11 limbs (36.7%) didn't develop complications and 19 limbs (63.3%) underwent complications. In Group B 25 limbs (83.3%) passed without complications and 5 patients (16.7%) with complications; less post-operative pain; pain score in Group (A) was (5.95±1.99) vs. (2.9±1.93) in Group (B) and p-value: 0.001.
Conclusions: Due to innovations in endovascular tech-niques and as it is a minimal invasive; proudure angioplasty became the first line of treatment of BK PAD. Endovascular intervention treat the lesion and keep the arterial tree with its native anatomical pattern so angioplasty can be done again if restenosis occur. Unlike surgical intervention in which it's too difficult to re-interfere after surgical bypass.