Kissing-balloon technique for infrapopliteal angioplasty in patients with critical limb ischemia

Abstract Objective This study aimed to analyze the technical aspects and follow-up findings regarding patients with critical limb ischemia who underwent the kissing-balloon technique (KBT). Methods Thirty patients (34 bifurcations) were enrolled in this retrospective analysis between September 2010 and February 2017. All patients were submitted to infrapopliteal intervention for critical limb ischemia. The KBT was the primary treatment in three situations: for cases with >70% stenosis of the main artery at located less than 1cm to the bifurcation, occlusion of one branch with greater than 50% stenosis of the contralateral branch, or greater than 50% bilateral stenosis. Stents were considered in cases of recoil greater than 30% or flow-limiting recoil and were used in 7 of the 34 bifurcations (20.5%). Result Primary patency at 30 days, 1 year, and 2 years was 100%, 68.1% and 68.1, respectively. Limb salvage rates at 30 days, 1 year and 2 years were 100%, 86.6%, and 65.0%, respectively. Wound healing rates at 30 days, 6 months, 1 year, and 2 years were 7.1%, 34.4%, 44.5%, and 68.7%, respectively. The bifurcations of the V-shape and T-shape groups were compared in terms of wound healing, primary patency, and limb salvage. No differences were observed in wound healing (P=0.268), primary patency (P=0.394), and limb salvage (P=0.755). Conclusions The kissing-balloon technique is a feasible bifurcation approach for infrapopliteal angioplasties to maintain the patency of both branches after ballooning. The comparison between the anterior tibial artery and tibioperoneal trunk bifurcation and the peroneal artery and posterior tibial artery bifurcation revealed no difference in wound healing, primary patency, and limb salvage.