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Related Concept Videos

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation

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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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Peripheral Artery Disease V: Postoperative Nursing Management01:23

Peripheral Artery Disease V: Postoperative Nursing Management

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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Pulse Assessment Sites01:11

Pulse Assessment Sites

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Pulse assessment sites are crucial in evaluating a patient's cardiovascular health. By assessing the pulsations of arteries at specific anatomical locations, healthcare professionals can gather valuable information about blood flow, heart rate, and peripheral circulation. Understanding these pulse assessment sites is essential for conducting comprehensive cardiovascular evaluations and monitoring patients' overall health. These sites are strategically chosen due to the accessibility and...
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Peripheral Artery Disease IV: Nursing Management01:26

Peripheral Artery Disease IV: Nursing Management

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 The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
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Peripheral Artery Disease I: Introduction01:30

Peripheral Artery Disease I: Introduction

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Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs, particularly the arteries supplying the thighs and calves. In rare cases, it may involve other arteries, including those in the arms.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty...
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Related Experiment Video

Updated: May 1, 2026

High-Resolution Three-Dimensional Imaging of the Footpad Vasculature in a Murine Hindlimb Gangrene Model
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Pedal access in critical limb ischemia.

C Walker1

  • 1Cardiovascular Institute of the South, Houma, LA, USA - drcrwalker@aol.com.

The Journal of Cardiovascular Surgery
|March 28, 2014
PubMed
Summary

The transpedal approach offers a viable solution for critical limb ischemia (CLI) patients when standard endovascular methods fail. This retrograde technique successfully treated most patients, improving limb salvage outcomes.

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.

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  • 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.