TIBIAL CORTICOTOMY AND PERIOSTEAL ELEVATION FOR CHRONIC CRITICAL LOWER LIMB ISCHAEMIA

Aim: Estimating procedure s safety; efficiency, efficacy and cost/benefit. Methods: Thirty six patients were enrolled. Preoperative demographic data, ankle systolic pressure, and magnetic resonance angiography were obtained. Early results (1st month) included skin perfusion and pain, late results involved wound healing, pain, Kelker score, procedure morbidity, patient satisfaction and quality of life. Results: Mean age ±SD was 68.03 ±5.5, males were 23(63.9%), twenty (55.6%) patients had ankle systolic pressure 0 mmHg and 29 (80.5%) with infrainguinal disease .Within the 1st month; skin perfusion and rest pain improved in 91.7%, 86.1%, patients respectively. Magnetic resonance angiography at the 2nd month declared vascular response for all patients. By the end of 1st year 34(94.4%) patients achieved complete wound healing, also rest pain and claudication relief occurred in 86.1% 55.6% patients, with20 (55.6%) patients had excellent score. Procedure morbidity was (17.7%).Satisfaction measures at six and twelfth months were mean ±SD 7.1 ±1.3, 8.7±1.7 respectively. Twelfth month quality of life improved (overall score P = 0.05, mental health scale 0.05 and pain/anxiety domain P 0.001). Conclusion: The procedure represents an invaluable tool to be evaluated in randomized study