الفهرس 
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Abstract
This study was conducted during July 2018 through February 2019. It included thirty patients who have been admitted to vascular surgery department at Minia University Hospitals. Patients have been admitted one or two days before intervention to be prepared for endovascular intervention.
Full records of all patients have been done including all data in the vascular sheet including (personal history, history of any chronic illness or risk factors, previous history of any vascular operation or amputation and history of hypersensitivity to contrast).
Full examination of all patients has been done including (physical, general, abdominal and local examination).
Full laboratory investigations of our patients, cardiological and internal medicine consultation have been done for our patients.
All patients submitted to arterial duplex scan and some of them needed CT angiography.
All patients were prepared for endovascular intervention by taking loading dose of clopidogril except those on maintenance dose, oral acetylcysetine and good hydration.
Informed written consent was obtained prior to participation in the study from all patients.
In our procedure the patient lie in supine position under C-arm with local anesthesia, most of cases submitted to ipsilateral antegrade access but when it faliled we entered via retrograde trans pedal access, angiography was done before introduction of guide wire as angiography is more accurate than arterial duplex and CT angiography to mark the lesions. Then we selected the vessels which need to be revascularized so in our study we tried to revascularize more than one tibial vessel in cases with gangrene or ulcers.
We used 0.035 guide wires or 0.018 guide wires to cross the lesions and in some cases we used double wire technique, using balloons with diameters ranging from 2.5 in our study. Following success of our procedure clinically or immediate angiography.
Most of patients were discharged on the second day after instructing them about risk factors, post procedure medication and foot care including minor debridement, limited amputation, antibiotics, and appropriate footwear. Follow up our cases in our outpatient clinic.
Our study included 10 patients presented with claudication, 24 patients with rest pain, 10 patients with ischemic ulcers and 23 patients with gangrene. There was significant improvement of walking distance post intervention for 8 cases with relief of claudication, resolution of rest pain occurred in 20 cases presented with rest pain. Also healing of ulcers and amputation stumps was noticed in most cases with gangrene and ulcers.
Results of follow up 6 months post procedure were very encouraging, primary patency was about 85.2% while 4 cases (14.8%) of re-stenosis were found which required another endovascular intervention or open surgery, this result compared with other studies encourage us to manage patients complaining of only claudication with endovascular revascularization.
There were some complications happened during or after angioplasty as perforation, 4 cases had intimal dissection but they were managed with balloon angioplasty immediately. Only 3 cases of puncture site hematoma, two cases were managed conservatively and the third case managed surgically, and one case complicated by mild blood loss that was controlled by blood transfusion post intervention. Two cases complicated with perforation that were sealed via balloon inflation finally 2 cases needed major amputation due to endovascular management were very difficult to cross the lesion not due to technical complication.no one dye during our study.