[Mid-term results of endovascular revascularization through primary retrograde distal access]

To evaluate the mid-term results of endovascular revascularization of the lower extremities through primary retrograde distal approach.

We prospectively analyzed the mid-term results of 74 endovascular surgeries via primary retrograde distal approach in 69 patients with lower extremity ischemia. Mean age of patients was 68.6±8.9 years. Men prevailed (66.2%); 50% of patients suffered from diabetes mellitus. In 70.3% of cases, the indication for intervention was ischemic ulcerative-necrotic defects of the foot. Revascularization through anterior tibial artery was the most common (63.5%). Angiosomal artery was catheterized in 59.6% of cases; the only patent lower leg vessel - in 25.7% of cases. Antegrade recanalization of "adjacent" tibial artery via distal approach was performed in 40.5% of cases.

Distal access was successful in all cases. Retrograde revascularization (restoration of blood flow to the foot through at least one tibial artery) was successful in 91.9% of cases. Conversion to antegrade intervention was necessary in 8.1% of cases. Recanalization of adjacent tibial artery was successful in 100% of cases. Direct revascularization of the affected angiosome was performed in 76.9% of patients with foot tissue necrosis, indirect revascularization through collaterals - in 23.1% of cases. Access-related morbidity was 8.1%, all complications were local in nature. Most of them (83.3%) regressed without loss of arterial patency. Freedom from limb amputation and thrombosis of access-related artery within two years was 87.0% and 88.1%, respectively. Occlusion of access-related artery immediately before amputation was observed only in 1 case.

Endovascular revascularization through primary retrograde distal access is effective and safe. Freedom from limb amputation and thrombosis of access-related artery within two years is high.