Short term outcome of retrograde tibiopedal access in management popliteal and infrapopliteal disease

Authors

  • Baker Ghoneim Department of Vascular Surgery, Cairo University, Cairo, Egypt http://orcid.org/0000-0001-5972-9806
  • Mahmoud Nasser Department of Vascular Surgery, Cairo University, Cairo, Egypt
  • Mohamed Ali Department of Vascular Surgery, Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20185476

Keywords:

Infrapopliteal disease, Popliteal occlusion, Retrograde, Tibiopedal

Abstract

Background: Aim was to evaluate the safety and efficacy of retrograde tibiopedal access after failed antegrade recanalization in patients with femero-popliteal and infrapopliteal occlusions.

Methods: This is a retrospective study including patients presenting with critical limb ischemia due to femero-popliteal and infrapopliteal occlusions for whom retrograde transpedal/tibial access was used after failure of antegrade approach at the vascular surgery unit in Kasr Al Aini hospitals in the period from June 2015 to June 2017.

Results: The study included 18 patients with a mean age of 64 years and male to female ratio 2.6:1. All patients presented with CLI (Rutherford category 4-6), all lesions were Trans Atlantic Society Consensus (TASC) II D, and Technical success was accomplished in 17 cases (94.4 %). In one case, failure to cross the target lesion via both antegrade and retrograde accesses occurred and the patient was immediately converted to an open surgery (popliteal tibial bypass). Complications included 2 puncture site hematoma that were managed conservatively; no AVF. There was no perioperative mortality. Primary patency was 81.25 % at 6 month.

Conclusions: retrograde tibiopedal access is safe and effective technique after failed antegrade recanalization in patients with popliteal and infrapopliteal occlusions.

References

Dieter RS, Nanjundappa A. Pedal artery access for critical limb ischemia. Vascular Disease Management; 2011

Mousa AY DR, Nanjundappa A. Anatomy of the pedal arch and implications for tibiopedal access: an overview of anatomical characteristics and access options for challenging CLI cases. Endovascular Today. 2012:S3-S5.

Nanjundappa A BB, Kathari P, Bernardo NL, Khatib Y, Mousa AY, Dieter RS, et al. Transpedal artery access for tibiopedal lesions. Tools and techniques for achieving revascularization. Endovascular Today. 2012 S6-S8.

Saito S. Different strategies of retrograde approach in coronary angioplasty for chronic total occlusion. Catheterization Cardiovascular Interventions. 2008 Jan 1;71(1):8-19.

Iyer SS, Dorros G, Zaitoun R, Lewin RF. Retrograde recanalization of an occluded posterior tibial artery by using a posterior tibial cutdown: two case reports. Catheterization Cardiovas Diag. 1990 Aug;20(4):251-3.

Vance AZ, Leung DA, Clark TW. Tips for pedal access: technical evolution and review. J Cardiovas Surg. 2018 Jun.

Dua A, Chandra V. Retrograde pedal access-cutting edge or comical? Vascular Endovas Surg. 2018;1-3.

Downer UR. Percutaneous retrograde tibial access in the endovascular treatment of acute limb ischaemia: a case report. Eur J Vasc Endovasc Surg. 2007;34:350-2.

Fusaro M TA, Mollichelli N, Medda M, Inglese L, Biondi-Zoccai GG. Retrograde pedal artery access for below-the-knee percutaneous revascularisation. J Cardiovasc Med. 2007;8(3):216.

Kawarada O, Yokoi Y, Sekii H, Higashiue S. Retrograde crossing through the pedal arch for totally occluded tibial artery. J Interventional Cardiol. 2008 Aug;21(4):342-6.

Walker C. Durability of PTAs using pedal artery approaches. In 37th Annual VEITH Symposium 2010 Nov 18.

Bazan HA, Le L, Donovan M, Sidhom T, Smith TA, Sternbergh III WC. Retrograde pedal access for patients with critical limb ischemia. J Vas Surg. 2014 Aug 1;60(2):375-82.

Gandini PV, Stefanini M, Maresca L, Spinelli A, Colangelo V, et al. The “Safari” technique to perform difficult subintimal infragenicular vessels. Cardiovasc Intervent Radiol. 2007;30(3):469-73.

Botti CF, Ansel GM, Silver MJ, Barker BJ, South S. Percutaneous retrograde tibial access in limb salvage. J Endovas Ther. 2003;10(3):614-8.

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Published

2018-12-27

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Original Research Articles