Pedal access in critical limb ischemia

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Endovascular Therapy

Background:

• Critical limb ischemia (CLI) often involves complex popliteal and infrapopliteal arterial occlusions.
• Surgical revascularization for CLI can be challenging due to poor distal targets and patient comorbidities.
• Endovascular therapy is an alternative, but crossing chronic total occlusions can be difficult.

Purpose of the Study:

• To describe a 13-step transpedal (retrograde) approach for treating CLI patients with uncrossable occlusions.
• To evaluate the safety and efficacy of the transpedal approach in limb salvage interventions.
• To assess outcomes in patients who failed antegrade crossing attempts.

Main Methods:

• A retrograde transpedal approach was used via anterior tibial, posterior tibial, or peroneal arteries.
• The technique was applied to 228 CLI patients who failed antegrade crossing.
• Outcomes including access success, intervention success, and complications were recorded.

Main Results:

• Successful pedal access was achieved in 95% (217/228) of patients.
• Successful endovascular intervention was accomplished in 93% (199/217) of those with pedal access.
• No bleeding complications occurred, and only one instance of pedal occlusion was reported.

Conclusions:

• The transpedal approach is a safe and effective technique for limb salvage in CLI patients with complex occlusions.
• This retrograde strategy provides a viable option when antegrade endovascular crossing fails.
• The described 13-step technique facilitates successful intervention in challenging cases.