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Retrograde Tibioperoneal Access for Complex Infrainguinal Occlusions: Short- and Long-Term Outcomes of 554

Andrej Schmidt1, Yvonne Bausback1, Michael Piorkowski2

  • 1Division of Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany.

JACC. Cardiovascular Interventions
|September 7, 2019
PubMed

Insights

Retrograde tibioperoneal access offers a safe and effective endovascular treatment for chronic total occlusions (CTOs) when antegrade approaches fail. This method demonstrates a high success rate with rare complications, improving outcomes for patients with critical limb ischemia.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Endovascular Therapy

Background:

  • Antegrade recanalization of peripheral chronic total occlusions (CTOs) often has a high failure rate.
  • Retrograde tibioperoneal artery access is an alternative strategy to overcome limitations of the antegrade approach.

Purpose of the Study:

  • To evaluate the short- and long-term efficacy and safety of retrograde tibioperoneal access for endovascular treatment of infrainguinal CTOs.
  • To report outcomes in patients with critical limb ischemia (CLI) and claudicants.

Main Methods:

  • Retrospective single-center cohort study of 554 infrainguinal occlusions requiring retrograde tibioperoneal access.
  • Data collection included access techniques, lesion crossing, treatment modalities, and short- and long-term outcomes up to 4 years.
  • Survival analysis was used for long-term outcome assessment.

Main Results:

  • Retrograde access was successful in 98.6%, with lesion crossing achieved in 95.1%.
  • Complications at the distal puncture site were infrequent (3.3%).
  • One-year freedom from target lesion revascularization was 74.6% for claudicants and 62.2% for CLI patients; restenosis rates were 67.5% and 36.0%, respectively.

Conclusions:

  • Retrograde tibioperoneal access is a safe and effective option for complex CTO recanalization following failed antegrade attempts.
  • Puncture site complications are rare, supporting the safety profile of this technique.
Abstract

Keywords:
chronic total occlusionsperipheral arterial diseaserestenosistibioperoneal access

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