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Retrograde Peroneal Artery Approach to Treat Infra-Inguinal Arterial Chronic Total Occlusions: A Multicentre
Lorenzo Patrone1, Gianmarco Falcone2, Raphael Coscas3
1West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow HA1 3UJ, UK.
Insights
Retrograde peroneal artery access is a safe and effective technique for complex infrainguinal endovascular recanalizations when antegrade approaches fail. This method demonstrates high technical success and low complication rates in experienced centers.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Endovascular Therapy
Background:
- Retrograde peroneal artery (PA) access is technically challenging and carries bleeding risks.
- Infrainguinal endovascular recanalizations often require alternative access routes after failed antegrade attempts.
- Chronic limb-threatening ischemia (CLTI) and chronic total occlusions (CTO) present significant challenges in lower extremity revascularization.
Purpose of the Study:
- To evaluate the safety, feasibility, and technical success of retrograde PA access for infrainguinal endovascular recanalizations.
- To assess complication rates associated with retrograde PA access in a multicenter setting.
- To determine the efficacy of this approach in patients with previously failed antegrade recanalization attempts.
Main Methods:
- Retrospective analysis of 186 patients undergoing endovascular recanalization of infra-inguinal lesions via retrograde PA access.
- Data collected over a 7-year period (May 2014-August 2021) from a multicenter study.
- Retrograde PA access was utilized exclusively after failed antegrade crossing attempts.
Main Results:
- Successful retrograde PA access was achieved in 91.9% (171/186) of cases.
- The overall rate of PA puncture-related complications was low at 2.1%, including minor bleeding and arteriovenous fistulas.
- The 30-day Major Adverse Event (MAE) rate was 1.6% (3/186).
Conclusions:
- Retrograde peroneal artery access is a safe and effective strategy for treating complex infrainguinal lesions.
- This technique is particularly valuable in cases where conventional antegrade recanalization attempts have failed.
- Experienced vascular teams can achieve high technical success with minimal complications using retrograde PA access.
Abstract:
Background/Objectives: Retrograde access of the peroneal artery (PA) is considered technically challenging and at risk of bleeding. The aim of this multicentre retrospective study was to assess the safety, feasibility, and technical success of this access route for infrainguinal endovascular recanalizations. Methods: We retrospectively analyzed 186 consecutive patients treated over a 7-year period (May 2014-August 2021) who underwent endovascular recanalization of infra-inguinal lesions using a PA access route. In all cases, retrograde PA access was obtained following a failed attempt to cross the occlusion via the antegrade route. Results: Among the 186 patients, 120 were males (60.5%) and the mean age was 76.8 ± 10.7 years old (44-94 years). One hundred and thirteen patients (60.7%) suffered from chronic limb threatening ischemia (CLTI). All patients presented with chronic total occlusions (CTO) and a failed conventional antegrade recanalization attempt. Retrograde access was performed under angiographic guidance in 185 cases (99.5%). It was successfully established in 171 cases (91.9%). The total rate of retrograde puncture-related complications was 2.1% (two puncture site bleedings of which one necessitated fasciotomy and two cases of arteriovenous fistulas managed conservatively). The Major Adverse Event (MAE) rate at 30 days was 1.6% (3/186). Conclusions: Retrograde recanalization of challenging infra-inguinal lesions via PA is safe and effective in experienced hands.
