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Retrograde Pedal Access via Occluded Arteries in Endovascular Treatment of Critical Limb Ischemia

Sadık Ahmet Uyanık1, Umut Öğüşlü1, Birnur Yılmaz1

  • 1Department of Radiology, Okan University Hospital, Aydınlı Cad. No: 2 Okan Universitesi Hastanesi İçmeler, Tuzla, İstanbul, Turkey.

Journal of Vascular and Interventional Radiology : JVIR
|November 29, 2020
PubMed

Insights

Retrograde pedal access via occluded arteries is feasible for critical limb ischemia (CLI) when antegrade approaches fail. While technical success is lower, this method allows angiosome-directed therapy for improved outcomes.

Area of Science:

  • Vascular Surgery
  • Endovascular Interventions
  • Critical Limb Ischemia

Background:

  • Critical limb ischemia (CLI) poses significant challenges for limb salvage.
  • Antegrade endovascular approaches are standard but can fail due to occluded pedal arteries.
  • Alternative access strategies are crucial for successful CLI treatment.

Purpose of the Study:

  • To assess the feasibility and technical outcomes of retrograde pedal access through occluded arteries in CLI patients.
  • To compare outcomes between retrograde access via occluded versus patent pedal arteries.
  • To evaluate the role of retrograde pedal access when antegrade approaches fail.

Main Methods:

  • Retrospective evaluation of 151 CLI patients treated with retrograde pedal access (Jan 2016 - Jan 2018).
  • Patients divided into 'occluded' (n=70) and 'nonoccluded' (n=81) pedal artery groups.
  • Comparison of pedal access success, lesion crossing, angiographic success, technical success, and complications.

Main Results:

  • Pedal access and lesion crossing success rates were comparable between occluded and nonoccluded groups (P > .05).
  • Angiographic and overall technical success rates were significantly lower in the occluded group (P < .05).
  • Procedure-related complications were similar between the two groups (P = .096).

Conclusions:

  • Retrograde pedal access via occluded arteries is a feasible option for CLI treatment when antegrade access fails.
  • Despite lower technical success, this approach enables angiosome-directed therapy.
  • This strategy holds potential for improving CLI treatment outcomes.
Abstract

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