How I do it: Pedal access and pedal loop revascularization for patients with chronic limb-threatening ischemia

Kuroki, Marcos T.; Parikh, Umang; Chandra, Venita

doi:10.1016/j.jvscit.2023.101236

Cited by 1 publication

(1 citation statement)

References 41 publications

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“…On the other hand, the outcomes of the Best Surgical Therapy in Patients With Critical Limb Ischemia (BEST-CLI) study stated that the use of retrograde tibial access should be reserved for a specific cohort of patients with CLTI in which single-segment saphenous vein bypass is not an option. 7 Tibiopedal access provides a viable alternative in EVT for CLI patients who are high risk for surgery and unable to undergo common femoral artery (CFA) access due to body habitus or comorbidities. It also has the advantage of avoiding the use of re-entry devices and its associated costs while offering a better chance of success due to the softer, less calcified distal plaque compared with the proximal plaque.…”

Section: Discussionmentioning

confidence: 99%

Role of Retrograde Tibiopedal Access in Limb Salvage in Patients with Critical Lower Limb Ischemia

Ghoneim,

Elhindawy,

Fouad

et al. 2024

Int J Angiol

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The aim of this study was to assess the efficacy and safety of retrograde tibiopedal access as an alternative approach in cases of critical limb ischemia (CLI) when antegrade access has failed. A prospective study was conducted that included patients with CLI who underwent tibiopedal access after failed antegrade recanalization from January 2018 to June 2022. Follow-up was conducted at 6, 12, and 24 months. The primary outcomes evaluated were technical success rate and primary patency. Secondary outcomes included complication rate, mortality rate, and limb salvage rate (LSR). Forty-eight patients had CLI and Trans Atlantic Inter-Society Consensus infrainguinal lesions. The retrograde approach was used through the anterior tibial artery in 28 patients (58%), the posterior tibial artery in 18 patients (37.5%), and the peroneal artery in 2 patients (4.5%). Technical success was achieved in 90% of patients (43 patients). There was a significant increase in the anklebrachial index after the procedure with a mean follow-up of 22 months. Twenty-two months primary patency rate was 85.2%, while secondary patency rate was 100% and LSR was 96%, respectively. There was no mortality in the series. Retrograde tibiopedal approach is an alternative option for managing peripheral arterial disease and CLI. This method offers another means of crossing lesions when antegrade access failed, and the intervention can be completed either in an antegrade or retrograde approach. As the retrograde approach does not impact access site, considered a feasible safe treatment alternative which increase the success rate of endovascular treatment.

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Section: Discussionmentioning

confidence: 99%