Retrograde approach for complex popliteal and tibioperoneal occlusions

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Peripheral Artery Disease

Background:

• Complex popliteal and tibioperoneal occlusions present a significant challenge in endovascular treatment.
• Antegrade revascularization approaches have limitations and can fail in a notable percentage of cases.

Purpose of the Study:

• To detail the technical aspects of the retrograde approach for endovascularly treating complex popliteal and/or tibioperoneal occlusions.
• To evaluate the efficacy of the retrograde approach in reducing endovascular treatment failure rates.

Main Methods:

• An observational registry of retrograde revascularizations was analyzed over 14 months.
• The study included patients whose antegrade revascularization attempts for complex occlusions failed.
• Treatments were performed via percutaneous transpedal access or transcollateral intra-arterial techniques.

Main Results:

• The retrograde approach achieved an overall success rate of 86.3% (44/51 limbs).
• Adjunctive stenting was required in 41.1% of cases to optimize outcomes.
• Major complications were low (1.9%), with only one pedal access site occlusion reported.

Conclusions:

• The retrograde approach is a feasible and safe adjunct for complex popliteal to infrapopliteal occlusions when antegrade attempts fail.
• This technique can effectively modify and reduce failure rates in challenging cases.
• Further large-scale studies are needed to confirm long-term safety, efficacy, and clinical benefits for critical limb ischemia patients.