Tibiopedal and distal femoral retrograde vascular access for challenging chronic total occlusions: predictors for technical success, and complication rates in a large single-center cohort

Abstract

Objective To evaluate the safety and effectiveness of tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion (CTO) in Rutherford stage III to VI peripheral arterial occlusive disease, and to determine factors that correlate with technical success. Material and methods One hundred seventy-one consecutive patients were included in this retrospective study. Rutherford stages were III, IV, and V/VI in 24%, 8%, and 67% of patients. Inclusion criteria were CTO at the superficial femoral (SFA), popliteal (PA), and/or below-the-knee (BTK) level, and a failed antegrade treatment followed by a distal retrograde approach. The numbers of occluded vascular levels (OVL), lesion length, degree of calcification, technical success rate, complications, and clinical outcome were noted. Results OVL were 1 in 72%, 2 in 20%, and 3 in 8% of patients. CTOs were longer than 20 cm in 45.6% of cases and showed severe calcifications in 50.3%. Target vessels for distal access were the distal SFA/PA in 17% and BTK in 83%. The overall technical success rate was 82%. Severe calcification decreased technical success (p = 0.01) despite lesion length and Rutherford stage. Clinical outcome improved in 123/152 patients with a significant increase of the median ABI (N = 158) from 0.53 (interquartile range 0.39 to 0.61) to 0.85 (0.59 to 1.03; p < 0.001). Complications were reported in 7.6% cases with 2.3% related to the distal vascular access. Conclusion The tibiopedal and distal femoral retrograde access presents a safe and effective treatment option of CTOs at the thigh and/ or BTK after a failed antegrade attempt improving clinical outcome. Technical success decreased with lesion's degree of calcification. Key Points • Safety and effectiveness of the tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion. • Target lesion's degree of calcification decreases technical success. • Complications related to the distal vascular access were rare.

Trans-pedal access for endovascular revascularization in complex infra-popliteal lesions in critically ischemic limb: A cohort study

“…In our study, The technical success was achieved in 20 cases with percentage of (83.3%), and not achieved in 4 cases (16.7%) only, however technical success rate of crossing of 82% was similar to previously published data ranging from 75 to 100% as reported by [ 15 ],also, Andrej Schmidt, MD et al in his study reported the retrograde access success in 98.6 % [ 16 ], the procedure success rates were very high (>95%) as reported in the study of [ 17 ]. Hosam El-Sayed et al in his study reported that the technical success rate of 67% was low, compared with earlier studies.…”

“…As regard indications of procedure: In our study, half of the cases indicated for rest pain (50%) and other half for tissue loss (37.5% for ulcer, 12.5% for gangrene), Hosam El-Sayed et al, reported in his study 19% of cases indicated for claudications, 5% for rest pain, 76% “majority of cases” for tissue loss [ 13 ], DM, CAD and HTN were present with percentage (94%), as reported in the literature [ 12 ], also, Zoltan Ruzsa et al, reported in his study that 53% 0f cases indicated for gangrene (majority), 37% for ischemic rest pain, 16% for ulcer [ 15 ].…”