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US-guided retrograde tibial artery puncture for recanalization of complex infrainguinal arterial occlusions
Serkan Gür1, Levent Oğuzkurt, Kamil Gürel
1Department of Radiology, Sifa University School of Medicine, Izmir, Turkey. mserkangur@yahoo.com
Insights
The retrograde tibial approach offers a safe and effective endovascular option for complex infrainguinal arterial occlusions, successfully increasing recanalization rates after traditional methods fail.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Complex infrainguinal arterial occlusions present a significant challenge in revascularization.
- Traditional antegrade approaches have limitations and can fail in complex cases.
Purpose of the Study:
- To describe the technical aspects and outcomes of the retrograde tibial approach with balloon predilation.
- To evaluate its efficacy in minimizing failure rates for complex infrainguinal arterial occlusions.
Main Methods:
- Retrospective analysis of 22 patients with failed antegrade revascularization for infrainguinal occlusions.
- Retrograde tibial artery puncture followed by percutaneous recanalization and predilation.
- Final angioplasty or stenting performed via antegrade femoral access.
Main Results:
- Successful tibial access in 100% of cases.
- Successful recanalization achieved in 82% of patients (18/22).
- Low complication rates: one major and one minor complication.
Conclusions:
- Retrograde tibial recanalization is a safe and feasible endovascular option for complex infrainguinal arterial occlusions.
- This technique increases success rates when traditional approaches fail.
- It offers an alternative to more invasive procedures.
Purpose:
We aimed to describe the technical aspects and outcomes of the retrograde tibial approach and balloon predilation for recanalization of complex infrainguinal arterial occlusions and determine the efficacy of this approach in minimizing failure rates.
Materials And Methods:
Between September 2006 and April 2011, antegrade revascularization failed in 22 limbs with complex total occlusions within the infrainguinal arterial territory. For each of these antegrade failure cases in 22 patients, a retrograde tibial puncture had been attempted. Percutaneous recanalization and predilation were initially performed through tibial access, and final balloon dilatation or stent placement was performed from antegrade femoral access. The patients were followed up for functionality and wound healing.
Results:
Access from the tibial artery was successfully obtained for all patients (100%). Successful recanalization was obtained in 18 patients (82%). Retrograde access was performed from the anterior tibial/dorsalis pedis artery in 12 patients and posterior tibial artery in 10 patients. One major and one minor complications were documented.
Conclusion:
Retrograde tibial recanalization technique in the infrainguinal complex arterial occlusion safely increases the success rates of percutaneous recanalization in the failed traditional approach and is a feasible endovascular option to avoid more invasive, time-consuming, and high-risk procedures.
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