Endovascular retrograde recanalization in Asian critical limb ischaemia patients

To evaluate endovascular retrograde recanalization of critical limb ischaemia (CLI) patients with chronic total occlusions (CTOs) in an Asian population.

We conducted a single centre-based retrospective review of CLI patients with CTOs who had undergone endovascular retrograde recanalization using the subintimal arterial flossing with antegrade-retrograde intervention technique.

A total of 40 CLI patients with CTOs underwent endovascular intervention. The median age was 71 years; 67.5% were males and Chinese accounted for 65% of the patients, of which 55% were in Rutherford category 6, 37.5% in category 5 and 7.5% in category 4. Antegrade-retrograde access was performed via the femoral artery in 39 cases and the brachial artery in one case for the proximal puncture, and the following arteries for the distal puncture: superficial femoral, n = 4 (10%); popliteal, n = 4 (10%); anterior tibial, n = 12 (30%); dorsalis pedis, n = 9 (22.5%); peroneal, n = 4 (10%) and posterior tibial, n = 7 (17.5%). Technical success was high at 92.5% (n = 37). After intervention, 25% (n = 10) had below-knee triple vessel runoff, 52.5% (n = 21) had double vessel runoff and 15.0% (n = 6) had single vessel runoff. Stenting for target vessel dissections was required in 12 patients. There were two cases of significant bleeding; one common femoral artery pseudoaneurysm was treated with ultrasound-guided thrombin injection and another case of distal puncture site bleeding only required compression. Limb salvage at 1 year was 92.5% (n = 37).

The subintimal arterial flossing with antegrade-retrograde intervention technique is safe with high technical success rates and acceptable outcomes in Asian CLI patients with CTOs.