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Transpedal access after failed anterograde recanalization of complex below‐the‐knee and femoropoliteal occlusions in critical limb ischemia
Author(s) -
Ruzsa Zoltán,
Nemes Balázs,
Bánsághi Zoltán,
Tóth Károly,
Kuti Ferenc,
Kudrnova Slavka,
Berta Balázs,
Hüttl Kálmán,
Merkely Béla
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25262
Subject(s) - medicine , revascularization , angioplasty , critical limb ischemia , surgery , balloon , popliteal artery , percutaneous , anterior tibial artery , radiology , artery , vascular disease , cardiology , arterial disease , myocardial infarction
Background Successful angioplasty is one of the main factor of limb salvage during critical limb ischemia. In complex femoropopliteal to infrapopliteal occlusions, an anterograde recanalization attempt can fail in up to 20% of the cases. The purpose of this dual center pilot study was to evaluate the acute success and clinical impact of retrograde transpedal access for retrograde below‐the‐knee and femoropopliteal chronic total occlusions after failed anterograde attempt and to access the late complications at the puncture site.Methods The clinical and angiographic data of 51 consecutive patients with CLI treated by retrograde transpedal recanalization between 2010 and 2011 were evaluated in a pilot study. We have examined the 2‐month and 1 year major adverse events (MAEs) and clinical success. In all cases after failure of the anterograde recanalization of occluded below‐the‐knee segments due to unsuccessful penetration or failed re‐entry, the anterior tibial or posterior tibial artery was punctured under fluoroscopic guidance and retrograde recanalization was performed. Direct revascularization was tried firstly following the angiographic zones, but in failed cases indirect revascularization was carried out with increasing the collateral flow to the wound.Results Successful direct retrograde revascularization was achieved successfully in 40 patients (78.4%) and indirect revascularization was done in 10 patients (19.6%). Revascularization was failed in one patient (2%). MAE at 2 and 12 months follow‐up was 6 (11.7%) and 11 (24%). Limb salvage at 2 and 12 months was 93% and 82.3%, respectively. Balloon angioplasty was performed in all interventions and provisional stenting was done in 34 patients (66.7%). One major and three minor vascular complications occurred after the procedure. The mean basal and control creatinine level was 120.9 ± 133.4 and 123.8 ± 131.3 μmol/L ( P = 0.83) after the procedure.Conclusion Failed antegrade attempts to recanalize CTO‐s of femoropopliteal and infrapopliteal vessels can be salvaged using a retrograde transpedal access, with a low acute and late complication rate. This technique could be valuable for patients with critical limb ischemia due to femoropopliteal and infrapopliteal occlusions. © 2013 Wiley Periodicals, Inc.