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Retrograde Revascularization of Tibial Arteries in Patients with Critical Limb Ischemia: Plantar-Arch Versus

Erik Stahlberg1, Andreas Stroth1, Alexander Haenel1

  • 1Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists
|August 7, 2021
PubMed

Insights

The transpedal-access approach for below-the-knee (BTK) revascularization showed higher procedural success compared to the plantar-arch approach. Calcifications impacted success in the plantar-arch method, but outcomes were similar for limb salvage and survival.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Endovascular Therapy

Background:

  • Critical limb ischemia (CLI) poses a significant challenge, often requiring below-the-knee (BTK) revascularization.
  • Antegrade approaches can fail, necessitating alternative retrograde strategies for BTK artery revascularization.

Purpose of the Study:

  • To compare the efficacy and safety of retrograde plantar-arch versus transpedal-access approaches for BTK revascularization.
  • To evaluate the impact of calcification on procedural success in these retrograde techniques.

Main Methods:

  • Retrospective analysis of 811 patients undergoing BTK revascularization, focusing on 115 with prior failed antegrade attempts.
  • Patients were divided into plantar-arch (PLANTAR) and transpedal-access (TRANSPEDAL) retrograde groups.
  • Endpoints included technical success, procedural success, complications, limb salvage, and survival, with analysis of calcification's influence.

Main Results:

  • Procedural success was significantly higher in the TRANSPEDAL group (52%) compared to the PLANTAR group (34%) (p=0.04).
  • Calcification at the pedal-plantar loop and tibial target lesion significantly hindered technical and procedural success in the PLANTAR group.
  • No significant differences were observed in technical success, complications, limb salvage, or survival between the two retrograde approaches.

Conclusions:

  • The transpedal-access approach offers a higher procedural success rate for BTK revascularization after failed antegrade attempts.
  • Calcification is a critical factor for failure in the plantar-arch retrograde approach.
  • Both retrograde techniques demonstrate comparable feasibility, safety, and long-term limb salvage and survival rates.
Abstract

Keywords:
critical limb ischemiaendovascularlimb salvageretrogradetibial artery

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