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

Abstract

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.

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

“…11 Additionally, pedal access has been successfully used as a bailout procedure after complications from a traditional femoral approach in an SFA intervention. 12 El-Sayed et al 13 performed a retrospective study of patients with tibial vessel disease who had failed antegrade revascularization. They achieved successful revascularization in 67% of the patients, with an 88% limb salvage rate at 1 year.…”

Technical Success and Complication Rates of Retrograde Arterial Access for Endovascular Therapy for Critical Limb Ischaemia: A Systematic Review and Meta-Analysis

“…2 In those patients with complex CLI lesions, who may also be poor candidates for surgical revascularisation, a failed antegrade endovascular treatment could be salvaged through a distal retrograde approach. 5e7, 30,33,55 In this systematic review, with 96% of the patients having a CTO, retrograde access was mainly obtained after a failed antegrade approach, facilitating angioplasty and eventually leading to favourable technical (96%) and procedural success rates (91%). There are several reasons why these complex lesions could be more conducive to crossing retrogradely via tibioperoneal arterial conduits.…”

Kissing Balloon Technique for Angioplasty of Tibioperoneal Arteries Bifurcation Using Pedal Arterial Retrograde Revascularization

“…We also believe that the addition of retrograde pedal approach for KBT in this complex diseased cohort of patients is extremely valuable in achieving quicker therapy and shorter procedure time by reducing the likelihood of entering collateral vessels while trying to cross the actual lesions as these collaterals arise at caudal angles [5, 6]. In addition, the success of pedal approach is likely influenced by better push ability for the wires, balloons, and devices due to relatively smaller artery diameter and close proximity of the chronic total occlusion (CTO) segment of the artery to the access site [7].…”

“…In addition, the success of pedal approach is likely influenced by better push ability for the wires, balloons, and devices due to relatively smaller artery diameter and close proximity of the chronic total occlusion (CTO) segment of the artery to the access site [7]. It is important to note that utilization of ultrasound is essential for pedal access since it improves accuracy and minimizes complications [6, 8]. In our case series, pedal access was achieved from the first attempt using ultrasound in all patients.…”