Tibiopedal Access for Crossing of Infrainguinal Artery Occlusions

Objective To compare the transpedal approach to established femoral approach for endovascular treatment of infrainguinal peripheral arterial disease. Background Endovascular treatment of infrainguinal peripheral arterial disease is on the rise. Femoral approach is widely used but has significant complications. Recently the primary transpedal approach has been described for endovascular interventions. We hypothesized that transpedal approach could reduce access site related complications. We compared the two approaches in a retrospective cross‐sectional study at a single center. Methods We analyzed demographics, procedural parameters, and complications in patients who underwent a primary transpedal approach for infrainguinal intervention and compared to patients with a traditional femoral approach in our outpatient based endovascular lab. Results The success rate for access was lower in transpedal group compared to femoral (94% vs. 100%, p = .0002). The contrast dose (44 ± 11 mL vs. 68 ± 13 mL, p < .0001), radiation dose (25 mGy [16–43] vs. 48 mGy [36–67], p < .0001) and fluoroscopy time (5.48 min [3.48–11.71] vs. 9.35 min [6.63–14.11], p < .0001) were significantly lower in transpedal group. Conclusion The transpedal approach for infrainguinal revascularization appears to be a reasonable primary approach with high success and low complication rate with significant reduction in radiation and contrast dose. These findings should be further studied in a randomized controlled trial.

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 85%

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Transpedal vs. femoral access for peripheral arterial interventions—A single center experience

Shah

Bortnick

Bertrand

et al. 2019

“…One of the challenges in endovascular interventions is lack of a real‐time hemodynamic measure, similar to FFR or iFR, to give functional and hemodynamic information of the severity. We and others have recently published several studies demonstrating that tibio‐pedal access for retrograde peripheral angiography and intervention is feasible, safe, and portend a low complication rate . Measuring pedal pressure from the tibio‐pedal access should be straightforward.…”

Section: Introductionmentioning

confidence: 99%

Functional hemodynamics assessment during endovascular Tibio‐pedal retrograde intervention of peripheral arterial disease

Kwan

Parikh

Patel

et al. 2019

Objective We sought to use a novel technique to measure the functional hemodynamics of peripheral arterial lesions during endovascular interventions. Background Functional hemodynamics has not been thoroughly evaluated during endovascular interventions. The aim of our study is to evaluate the feasibility and the potential benefits of pedal pressures measurements from tibio‐pedal access. Methods We retrospectively reviewed 100 consecutive patients who underwent endovascular interventions via tibio‐pedal artery access between October 3, 2018 and December 15, 2018. Baseline and postintervention pedal pressures from the pedal sheaths were measured. We also evaluated the pedal‐brachial index (PBI) which is defined as the pedal sheath pressure divided by the simultaneously brachial cuff pressure. We compared baseline pedal pressures, postintervention pedal pressures, baseline PBI, postintervention PBI, % change of PBI ([postintervention PBI minus baseline PBI]/baseline PBI), and resting ankle‐brachial index (ABI) versus baseline PBI in this cohort of patients. Results All 100 patients had successful tibio‐pedal artery access. Baseline pedal pressure was 70 + 30 mmHg with post intervention pedal pressure of 133 + 27 mmHg (p < .001). Baseline PBI was 0.75 + 0.24 with post intervention PBI of 1.09 + 0.19 (p < .001). The correlation coefficient of resting ABI vs. baseline PBI was 0.55. The % change of PBI was 63.2 + 52.4%. There was significant improvement of postintervention PBI when compared to baseline PBI in the majority of patients. Conclusions Obtaining pedal pressures and PBI from tibio‐pedal access can be a feasible tool for endovascular interventions. This simple technique can provide us important functional hemodynamics information before and after peripheral revascularization.

“…Few reports have described the tibiopedal access for infragenicular and possibly infrainguinal endovascular interventions in patients with advanced peripheral vascular disease . Good technical success rate with low complication rate have been reported.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transaxillary approach for peripheral endovascular interventions

Thawabi

Tayal

Hawatmeh

et al. 2019

Objectives To assess the safety and feasibility of percutaneous transaxillary (TAx) access for peripheral endovascular interventions. Background The common femoral artery (CFA) is the most commonly used access site for peripheral endovascular interventions. However, its use might be precluded in multiple circumstances. The axillary artery is comparable in size to the CFA and is less affected by atherosclerosis. Data regarding its percutaneous use in peripheral endovascular interventions are scarce. Methods Consecutive patients who underwent percutaneous TAx peripheral endovascular interventions were identified. Demographic and periprocedural data were extracted. Axillary artery access was obtained percutaneously with the arm abducted. A destination sheath was advanced to the relevant vessel. Endovascular interventions were performed using standard devices and techniques. Vascular closure devices were utilized to achieve hemostasis. Primary endpoints included procedural technical success, access‐related complications, and major adverse events (MAEs). Secondary endpoints included cannulation time, total procedure time, fluoroscopy time, and length of stay (LOS). Results Percutaneous TAx access was successfully utilized to perform 41 procedures in 29 patients, lacking a suitable conventional access. Three quarters of target vessels were infrainguinal. The lesions of 61% were classified as TransAtlantic Inter‐Society Consensus (TASC) C or D. Access‐related complications occurred in two procedures (5%). No MAEs occurred. Median cannulation time was 12 min, procedure time 135 min, fluoroscopy time 20 min, and LOS 1 day. Conclusions When no suitable access exists for lower extremity catheter‐based interventions, percutaneous TAx approach is a feasible and safe alternative. As such facility with this approach is a valuable asset for interventionalists.