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Percutaneous retrograde tibial access in limb salvage
Charles F Botti1, Gary M Ansel, Mitchell J Silver
1MidOhio Cardiology and Vascular Consultants, Inc., Columbus, Ohio 43214, USA. cfbotti@yahoo.com
Summary
Retrograde tibial access offers a new solution for chronic limb ischemia when standard methods fail. This technique successfully restored blood flow and promoted wound healing in most patients, improving limb salvage outcomes.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Peripheral Artery Disease
Background:
- Chronic limb-threatening ischemia (CLTI) poses significant challenges in vascular intervention.
- Antegrade access to infrapopliteal vessels can be difficult or impossible in complex occlusive disease.
Purpose of the Study:
- To present a novel technique for achieving percutaneous retrograde access of tibial vessels.
- To evaluate the efficacy of this approach following failed antegrade access in CLTI patients.
Main Methods:
- Six patients with failed antegrade access underwent retrograde tibial artery puncture.
- Successful wire passage into proximally patent vessels was achieved.
- Endovascular intervention was performed using standard techniques, followed by clinical assessment.
Main Results:
- Successful recanalization was achieved in all six patients.
- Five patients demonstrated rapid and significant wound healing, previously unresponsive to treatment.
- One patient experienced non-healing and ultimately succumbed to heart failure.
Conclusions:
- Retrograde tibial access is a valuable addition to the interventionalist's toolkit for CLTI.
- This technique can facilitate successful revascularization and improve limb salvage rates.