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Related Experiment Video

Updated: Feb 12, 2026

Author Spotlight: Using a Rabbit Model to Explore the Efficacy of Tuina in Treating Knee Osteoarthritis
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Below-the-Knee Retrograde Access for Peripheral Interventions: A Systematic Review.

Rutger H A Welling1, Olaf J Bakker2, Dierk Scheinert3

  • 11 Department of Vascular & Endovascular Surgery, University Medical Center Utrecht, the Netherlands.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists
|March 27, 2018
PubMed
Summary

Retrograde below-the-knee (BTK) vessel puncture is a safe and successful technique for peripheral endovascular interventions. This approach offers high success rates with a low complication profile, making it a viable option when antegrade access fails.

Keywords:
access site complicationsbelow-the-knee accessendovascular interventionsperipheral artery diseaseretrograde accessretrograde approachtibial arteryvascular access

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Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Peripheral Artery Disease

Background:

  • Antegrade access for peripheral endovascular interventions can be challenging.
  • Retrograde access below the knee (BTK) offers an alternative approach.
  • Assessing the safety and efficacy of BTK retrograde access is crucial.

Purpose of the Study:

  • To evaluate the hypothesis that retrograde BTK vessel punctures have an acceptably low complication rate.
  • To determine the procedural success of retrograde BTK access for peripheral interventions.

Main Methods:

  • Systematic review of MEDLINE and Scopus databases.
  • Inclusion of 19 articles (3 prospective studies) totaling 1905 interventions.
  • Outcome measures included access success, procedure success, and complications.

Main Results:

  • Retrograde BTK access was successful in 94.0% of attempts.
  • Technical success for interventions was 84.0%, with 86.0% lesion crossing rate.
  • Low complication rate reported: 4.1% distal access site complications.

Conclusions:

  • Retrograde BTK approach is safe and successful for peripheral endovascular interventions.
  • Consider this technique when antegrade access is not feasible or fails.
  • Further real-world data from nonexpert centers is needed for broader recommendations.