Retrograde tibial access for revascularization of chronic total occlusions in patients with chronic limb-threatening
Daniel Raskin1, Yiftach Barash1, Daniel Silverberg2
1Division of Diagnostic Imaging, Sheba Medical Center, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Insights
Tibial single access effectively treats chronic total occlusions (CTO) in patients with chronic limb ischemia (CLTI), achieving high success and low amputation rates.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Chronic total occlusions (CTO) pose significant challenges in treating chronic limb-threatening ischemia (CLTI).
- Tibial artery access is an alternative approach for complex lower extremity revascularization.
Purpose of the Study:
- To evaluate the efficacy and safety of single tibial artery access for treating CTO in patients with CLTI.
- To assess outcomes including freedom from major amputation and need for reintervention.
Main Methods:
- Retrospective analysis of 57 patients (59 limbs) treated for ipsilateral CTO via tibial artery access (March 2017-March 2021).
- Patient symptoms classified by Rutherford category.
- Primary endpoints: freedom from major amputation and reintervention at 1 year.
Main Results:
- Technical success rate of 97% (57/59 limbs).
- Mean occlusion length 186 mm; treated multilevel disease.
- One-year amputation-free survival was 91.2%; reintervention needed in 9 limbs.
- Three minor procedural complications, all managed successfully.
Conclusions:
- Single ipsilateral tibial artery access is a safe and effective strategy for treating CTO in CLTI patients.
- This approach offers a high rate of limb salvage and successful revascularization.
Purpose:
To evaluate tibial single access in treatment of chronic total occlusions (CTO) in patients with ipsilateral chronic-limb ischemia (CLTI).
Materials And Methods:
In this retrospective study, data was collected on patients treated for ipsilateral CTO via a tibial artery access between March 2017 and March 2021. Fifty-nine limbs in 57 patients, (42 men, average age 73 years; range 47-96) were treated. Patient's symptoms were classified in accordance with the Rutherford category. The end points were freedom from major amputation and the need for reintervention up to 1 year of follow up.
Results:
Out of the 59 treated limbs, technical success was achieved in 57 (97%). The treated multilevel segments involved 5 common and 12 external iliac arteries, 23 common and 37 superficial femoral arteries, 23 femoropopliteal segments, 14 popliteal arteries, and 4 bypasses. Mean length of occlusion was 186 mm (range 7-670). Rutherford classification of the treated limbs was category 5 and 6 in 45 patients and category 4 in 14 patients. Three procedural complications occurred and were successfully treated during the same procedure. No immediate post-procedural complication was encountered. Median follow-up was 13 months (range 1-45.3). Reintervention was required in 9 limbs, after an average of 6 months. One year free from amputation rate was 91.2%.
Conclusions:
Single access via the ipsilateral tibial artery can be a useful, effective, and safe approach for treating CTO in CLTI patients.
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:29Venous Thrombosis III: Interprofessional Care
01:20Arteries of Lower Limbs