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Outcomes of Peripheral Vascular Interventions via Retrograde Pedal Access for Chronic Limb-Threatening Ischemia in a

Mark Perry1, Peter W Callas2, Matthew J Alef1

  • 1University of Vermont Medical Center, Burlington, VT, USA.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists
|February 21, 2020
PubMed

Insights

Retrograde pedal access for chronic limb-threatening ischemia (CLTI) shows similar technical success and early complications compared to femoral access. However, pedal access had higher major adverse limb events (MALE) but comparable amputation-free survival (AFS) at one year.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Peripheral Vascular Interventions

Background:

  • Chronic limb-threatening ischemia (CLTI) poses significant risks of limb loss and mortality.
  • Peripheral vascular interventions (PVI) are crucial for limb salvage in CLTI patients.
  • Retrograde pedal access is an alternative approach for PVI when traditional access is challenging.

Purpose of the Study:

  • To evaluate the utilization and one-year outcomes of retrograde pedal access in PVI for CLTI.
  • To compare retrograde pedal access with traditional contralateral retrograde femoral access.

Main Methods:

  • Analysis of 159 patients undergoing PVI via retrograde pedal access from the VQI registry (Oct 2016-Sep 2017).
  • Propensity-matched comparison with 156 patients undergoing PVI with contralateral retrograde femoral access.
  • Comparison of technical success, access site complications, major adverse limb events (MALE), and amputation-free survival (AFS) at 1 year.

Main Results:

  • Technical success rates were similar between retrograde pedal access (87%) and femoral access (93%) (p=0.07).
  • Early access site complications were rare and comparable between groups.
  • One-year MALE rates were higher with pedal access (38%) versus femoral access (24%) (p=0.01), while AFS was similar (83% vs 86%, p=0.37).

Conclusions:

  • Retrograde pedal access demonstrates comparable technical success and early safety to femoral access for CLTI patients.
  • While MALE rates are higher with pedal access, amputation-free survival remains similar.
  • This suggests a potential tradeoff between limb salvage and the need for repeat interventions with pedal access.

Keywords:
amputationchronic limb-threatening ischemialimb salvagepedal accessperipheral vascular interventionregistry

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