Retrograde popliteal access to treat femoropopliteal artery occlusive disease

Komshian, Sevan; Cheng, Thomas W.; Farber, Alik; Schermerhorn, Marc L.; Kalish, Jeffrey; Rybin, Denis; Jones, Douglas W.; Siracuse, Jeffrey J.

doi:10.1016/j.jvs.2017.12.022

Cited by 14 publications

(14 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since that time there have been several case reports and single-center series describing this technique. [4][5][6][7][8] A prospective, nonrandomized, multicenter study reported outcomes only to 30 days. 9 Because the early success by pioneers and centers of excellence may not be replicated in real-world practice, this study analyzed the real-world use and outcomes of retrograde pedal access for peripheral vascular interventions (PVI) in patients with CLTI enrolled in a multicenter national quality improvement registry.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Peripheral Vascular Interventions via Retrograde Pedal Access for Chronic Limb-Threatening Ischemia in a Multicenter Registry

et al. 2020

View full text Add to dashboard Cite

Purpose: To describe the use and 1-year outcomes of retrograde pedal access during peripheral vascular interventions (PVI) for chronic limb-threatening ischemia (CLTI). Materials and Methods: From October 2016 to September 2017, 159 patients (mean age 71±10 years; 112 men) undergoing PVI via retrograde pedal access were enrolled in the multicenter Vascular Quality Initiative (VQI) registry. The pedal access approach included retrograde femoral (40%), antegrade femoral (26%), retrograde to antegrade femoral (22%), and pedal only (11%). A comparator group of 1972 patients (mean age 69±12 years; 1129 men) having a contralateral retrograde femoral access was established for propensity matching, which resulted in 156 patients per group. Procedure characteristics, technical success, and access site complications were compared. Major adverse limb events (MALE) and amputation-free survival (AFS) at 1 year were analyzed using the Kaplan-Meier method and Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: Technical failure was similar for retrograde femoral and pedal access (7% vs 13%, p=0.07). Complications were rare and included access site hematoma (2 vs 5, p=0.32) and target artery thrombosis (0 vs 2) for the femoral vs pedal access groups, respectively. The rates of MALE at 1 year were significantly lower after retrograde femoral access (24%) compared with pedal access (38%; log-rank p=0.01; HR 1.95, 95% CI 1.15 to 3.30). AFS estimates at 1 year were similar: 86% for retrograde femoral and 83% for pedal access (log-rank p=0.37; HR 1.32, 95% CI 0.73 to 2.39), as were major amputation estimates: 10% for retrograde femoral access and 13% for pedal access group (log-rank p=0.21; HR 1.58, 95% CI 0.77 to 3.26). Conclusion: In this analysis of multicenter registry data, retrograde pedal access in patients with CLTI had similar technical success and early complications in comparison with traditional contralateral retrograde femoral access. The rates of MALE were higher after pedal access but AFS was similar, indicating a tradeoff between limb salvage and repeat interventions.

show abstract

Section: Introductionmentioning

confidence: 99%

Outcomes of Peripheral Vascular Interventions via Retrograde Pedal Access for Chronic Limb-Threatening Ischemia in a Multicenter Registry

et al. 2020

View full text Add to dashboard Cite

show abstract

“…7,10,14,17,18 The 84.5% POA technical success rate was also similar to that of other studies, which reported a range between 80% and 100%. 9,12,15,16,19 This large range in POA technical success can be partly attributed to the wide variability in technique, which has included prone and/or supine patient positioning and differing usage of duplex guidance. 9,11,12,16,19 Although our study did not observe a statistically significant association between dialysis and technical success, dialysis was included as a forced variable in the multivariate regression model for technical failure due to its established association with inferior endovascular outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,10,13,14 In contrast, the use of retrograde POA has been noted to provide superior pushability and torquability in comparison to femoral access and may facilitate easier crossing of lesions through the softer distal cap of the occlusive atherosclerotic plaque. 9,[11][12][13]15 Recent improvements in technique have also decreased the rates of complications associated with early POA attempts. 9,16 However, the lack of a standardized POA protocol; inherent risks associated with the prone position; and difficulties associated with accessing a flexed leg, compressing the vessel after sheath removal, and obesity complicate the POA approach.…”

Section: Introductionmentioning

confidence: 99%

Periprocedural Outcomes of Popliteal vs Upper Extremity Access in the Treatment of Superficial Femoral Artery Occlusive Disease

et al. 2021

View full text Add to dashboard Cite

Purpose: Percutaneous lower extremity revascularization is being performed via upper extremity, pedal, or popliteal access with increasing frequency. This study aimed to compare periprocedural outcomes of popliteal (POA) and upper extremity (UEA) access for the treatment of isolated superficial femoral artery (SFA) occlusive disease. Materials and Methods: A retrospective cohort study compared the outcomes of patients undergoing primary percutaneous intervention of SFA occlusive disease with POA or UEA using the Vascular Quality Initiative database from December 2010 to June 2019. Our primary endpoint was technical success. Secondary endpoints included factors associated with perioperative complications. Results: A total of 349 patients underwent isolated SFA intervention through the popliteal, radial, or brachial artery. UEA was performed in 188 (53.9%) patients and POA in 161 (46.1%). Technical success with TASC A lesions was 95.8% and with TASC D lesions, 65.0%. POA had a higher proportion of TASC D lesions (24.8% vs 10.6%, p<0.001), and larger (≥7 Fr) sheath size (14.3% vs 2.7%, p<0.001). UEA had a higher proportion of no calcification (27.1% vs 11.2%, p<0.001), and smaller (4–5 Fr) sheath size (46.8% vs 34.8%, p=0.023). There was no difference in technical success between UEA and POA (88.8% vs 84.5%, p=0.230), which was also seen on multivariable analysis (p=0.985). Univariate analysis revealed technical failure was associated with TASC D lesions (45.7% vs 12.9%, p<0.001) and the presence of severe calcifications (39.1% vs 17.5%, p=0.002). Multivariable analysis confirmed technical failure was associated with degree of calcification (OR, 2.4; 95% CI, 1.18 to 4.89; p=0.016) and TASC D lesions (OR, 5.01; 95% CI, 2.45 to 10.24; p<0.001). Postoperative complications were associated with UEA on univariate (p=0.041) and multivariate analysis (OR, 2.08; 95% CI, 0.80 to 5.37; p=0.016). Access site complications were also associated with UEA compared to POA (4.3% vs 0.0%, p=0.027). Conclusions: There is no difference in technical success between UEA and POA when treating isolated SFA occlusive disease, and UEA is associated with a higher complication rate. Technical success is dependent on calcification and TASC II classification. Based on similar technical success rates and low complication rates, POA should be considered as a viable alternative to UEA when planning endovascular interventions.

show abstract

“…Despite various retrograde techniques reported in the literature, a below-knee access might be challenging, especially in patients with CLI, because vessels are typically small and diseased 2, 3. Not infrequently, severe arterial spasm that necessitates the need for vasodilators, such as nitroglycerin or papaverine, can occur 1, 4.…”

Section: Discussionmentioning

confidence: 99%

“…Not infrequently, severe arterial spasm that necessitates the need for vasodilators, such as nitroglycerin or papaverine, can occur 1, 4. Not surprisingly, retrograde tibial or pedal access is reported to have lower technical success and primary patency rates compared with antegrade femoral access 2, 4. In some complicated CLI cases, the technical success rate was reported to be as low as 63.5%, 5 and devastating complications have been reported 3, 6.…”

Section: Discussionmentioning

confidence: 99%

Augmented reality navigation to assist retrograde peroneal access for the endovascular treatment of critical limb ischemia

Liu

Wang

Wei

et al. 2019

Journal of Vascular Surgery Cases, Innovations and Techniques

View full text Add to dashboard Cite

Retrograde access is an alternative approach to endovascular intervention for critical limb ischemia but may be challenging in patients with poor below-knee vessel runoff. Here, we introduce an innovative technique based on an augmented reality navigation system to gain successful retrograde access to the peroneal artery of an 84-year-old woman with critical limb ischemia. Our result showed that this innovative technique had the potential advantage of influencing target vessel access selection with lower contrast material volume and radiation exposure compared with the conventional approach. More in-depth study is required to investigate the safety and efficacy of augmented reality-assisted vascular interventions.

show abstract

Retrograde popliteal access to treat femoropopliteal artery occlusive disease

Cited by 14 publications

References 19 publications

Outcomes of Peripheral Vascular Interventions via Retrograde Pedal Access for Chronic Limb-Threatening Ischemia in a Multicenter Registry

Outcomes of Peripheral Vascular Interventions via Retrograde Pedal Access for Chronic Limb-Threatening Ischemia in a Multicenter Registry

Periprocedural Outcomes of Popliteal vs Upper Extremity Access in the Treatment of Superficial Femoral Artery Occlusive Disease

Augmented reality navigation to assist retrograde peroneal access for the endovascular treatment of critical limb ischemia

Contact Info

Product

Resources

About