Percutaneous Retrograde Tibial Access in Limb Salvage

Botti, Charles F.; Ansel, Gary M.; Silver, Mitchell; Barker, Billie J.; South, Sheila

doi:10.1177/152660280301000330

Cited by 54 publications

(17 citation statements)

References 16 publications

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“…The single-center literature has documented these advantages as well as high success and low complication rates. 4 - 14 , 18 , 19 However, some debate persists, primarily centering on the proper role of tibiopedal revascularization as a treatment for severe claudication. 7 , 17 Although rare and not recorded in this clinical experience, acute and subacute thrombotic occlusion of the access vessel has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…With 2 exceptions, 18 , 19 the previously published series 4 - 14 used a tibiopedal approach following a failed antegrade attempt to cross, demonstrating that typical usage of the retrograde approach has been as a bailout option to avoid limb amputation. Both Mustapha et al 18 and Hanna and Prout 19 used a primary tibiopedal approach in cases in which body habitus, comorbidities, or complex angiographic characteristics precluded an initial antegrade attempt to cross.…”

Section: Discussionmentioning

confidence: 99%

“…Although the use of the tibiopedal approach has conventionally followed a failed antegrade attempt to promote limb salvage in CLI patients, 4 - 14 increasing recognition of the advantages of the tibiopedal approach relative to antegrade access and crossing, 15 - 17 combined with increasing expertise, improved tools, and the low reported risk of complications, 18 , 19 have led some institutions to permit a more liberal use of the tibiopedal approach. This trend includes the use of a retrograde approach as a primary treatment for patients who are poor candidates for an antegrade access 19 and for the treatment of PAD patients suffering from claudication (Rutherford categories 2–3) that has not yet progressed to CLI (Rutherford categories 4–6).…”

Section: Introductionmentioning

confidence: 99%

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Tibiopedal Access for Crossing of Infrainguinal Artery Occlusions

et al. 2016

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Purpose: To report a prospective, multicenter, observational study (ClinicalTrials.gov identifier NCT01609621) of the safety and effectiveness of tibiopedal access and retrograde crossing in the treatment of infrainguinal chronic total occlusions (CTOs). Methods: Twelve sites around the world prospectively enrolled 197 patients (mean age 71±11 years, range 41-93; 129 men) from May 2012 to July 2013 who met the inclusion criterion of at least one CTO for which a retrograde crossing procedure was planned or became necessary. The population consisted of 64 (32.5%) claudicants (Rutherford categories 2/3) and 133 (67.5%) patients with critical limb ischemia (Rutherford category ≥4). A primary antegrade attempt to cross had been made prior to the tibiopedal attempt in 132 (67.0%) cases. Techniques used for access, retrograde lesion crossing, and treatment were at the operator’s discretion. Follow-up data were obtained 30 days after the procedure. Results: Technical tibiopedal access success was achieved in 184 (93.4%) of 197 patients and technical occlusion crossing success in 157 (85.3%) of the 184 successful tibial accesses. Failed access attempts were more common in women (9 of 13 failures). The rate of successful crossing was roughly equivalent between sexes [84.7% (50/59) women compared to 85.6% (107/125) men]. Technical success did not differ significantly based on a prior failed antegrade attempt: the access success rate was 92.4% (122/132) after a failed antegrade access vs 95.4% (62/65) in those with a primary tibiopedal attempt (p=0.55). Similarly, crossing success was achieved in 82.8% (101/122) after a failed antegrade access vs 90.3% (56/62) for patients with no prior antegrade attempt (p=0.19). Minor complications related to the access site occurred in 11 (5.6%) cases; no patient had access vessel thrombosis, compartment syndrome, or surgical revascularization. Conclusion: Tibiopedal access appears to be safe and can be used effectively for the crossing of infrainguinal lesions in patients with severe lower limb ischemia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tibiopedal Access for Crossing of Infrainguinal Artery Occlusions

et al. 2016

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“…13 Botti et al, used only the 4-Fr introducer, which allowed passage of the 0.018-in wire but did not allow use of any adjunctive tools (such as catheters or balloons) to guide the wire through the occlusion. 14 Fusaro et al, described a sheathless approach, introducing only a 0.018-in guidewire through the puncture needle for passing the lesion, thus avoiding the introduction of a sheath and keeping the access site as small as possible. 9 The current Cook Medical Micropuncture®Pedal Access Set has a 4-Fr introducer with a 2.9-Fr inner diameter that allows passage of 0.018-or 0.014-in catheters or balloons as adjunctive tools for crossing the tibial occlusion.…”

Section: Discussionmentioning

confidence: 99%

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

2018

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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.

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“…In this paper we are describing the retrograde tibiopedal access approach as a bail-out approach for the management of CFA approach complications while treating PAD involving the superficial femoral artery. Since it was originally described by Spinosa et al and Botti Jr. et al, retrograde tibiopedal access has been well described in the literature as an effective, safe, and feasible approach with high technical success rate and relatively low procedural complication rates [ 2 , 3 ]. However, it is currently considered as an alternative endovascular approach for limb salvage in patients with CLI after failed antegrade femoral artery access approach or for patients who are not candidates for antegrade approach.…”

Section: Discussionmentioning

confidence: 99%

Retrograde Tibiopedal Access as a Bail-Out Procedure for Endovascular Intervention Complications

Amro

Gabi

Elhamdani

et al. 2016

Case Reports in Vascular Medicine

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Introduction. Retrograde pedal access has been well described in the literature as a secondary approach for limb salvage in critical limb ischemia (CLI) patients. In this manuscript we are presenting a case where retrograde tibiopedal access has been used as a bail-out procedure for the management of superficial femoral artery (SFA) intervention complications. Procedure/Technique. After development of a perforation while trying to cross the totally occluded mid SFA using the conventional CFA access, we were able to cross the mid SFA lesion after accessing the posterior tibial artery in a retrograde fashion and delivered a self-expanding stent which created a flap that sealed the perforation without the need for covered stent. Conclusion. Retrograde tibiopedal access is a safe and effective approach for delivery of stents from the distal approach and so can be used as a bail-out technique for SFA perforation.

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Percutaneous Retrograde Tibial Access in Limb Salvage

Abstract: Retrograde tibial access can be a valuable technique in the armamentarium of a peripheral interventionist treating patients with chronic critical limb ischemia.

Cited by 54 publications

References 16 publications

Tibiopedal Access for Crossing of Infrainguinal Artery Occlusions

Tibiopedal Access for Crossing of Infrainguinal Artery Occlusions

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

Retrograde Tibiopedal Access as a Bail-Out Procedure for Endovascular Intervention Complications

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