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Role of Retrograde Tibiopedal Access in Limb Salvage in Patients with Critical Lower Limb Ischemia
Baker M Ghoneim1, Khaled M Abdo Elhindawy1, Fouad S Fouad1
1Department of Vascular Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
Insights
Retrograde tibiopedal access offers a safe and effective alternative for critical limb ischemia (CLI) when traditional antegrade access fails. This technique significantly improves limb salvage rates and procedure success in complex peripheral arterial disease cases.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Peripheral Arterial Disease
Background:
- Critical limb ischemia (CLI) poses a significant risk for amputation.
- Antegrade access failure necessitates alternative revascularization strategies.
- Tibiopedal access provides a distal option for endovascular procedures.
Purpose of the Study:
- To evaluate the efficacy and safety of retrograde tibiopedal access.
- To assess its role as an alternative in failed antegrade access for CLI.
- To determine technical success, patency, and limb salvage rates.
Main Methods:
- Prospective study of 48 patients with CLI and TASC infrainguinal lesions.
- Retrograde tibiopedal access performed via anterior tibial, posterior tibial, or peroneal arteries.
- Follow-up at 6, 12, and 24 months assessing primary and secondary outcomes.
Main Results:
- 90% technical success rate achieved.
- Significant increase in anklebrachial index post-procedure.
- 22-month primary patency rate of 85.2%, 100% secondary patency, and 96% limb salvage rate.
- No mortality observed.
Conclusions:
- Retrograde tibiopedal access is a feasible and safe alternative for CLI management.
- It increases endovascular treatment success rates when antegrade access fails.
- This approach offers a valuable option for complex peripheral arterial disease.
Abstract:
The aim of this study was to assess the efficacy and safety of retrograde tibiopedal access as an alternative approach in cases of critical limb ischemia (CLI) when antegrade access has failed. A prospective study was conducted that included patients with CLI who underwent tibiopedal access after failed antegrade recanalization from January 2018 to June 2022. Follow-up was conducted at 6, 12, and 24 months. The primary outcomes evaluated were technical success rate and primary patency. Secondary outcomes included complication rate, mortality rate, and limb salvage rate (LSR). Forty-eight patients had CLI and Trans Atlantic Inter-Society Consensus infrainguinal lesions. The retrograde approach was used through the anterior tibial artery in 28 patients (58%), the posterior tibial artery in 18 patients (37.5%), and the peroneal artery in 2 patients (4.5%). Technical success was achieved in 90% of patients (43 patients). There was a significant increase in the anklebrachial index after the procedure with a mean follow-up of 22 months. Twenty-two months primary patency rate was 85.2%, while secondary patency rate was 100% and LSR was 96%, respectively. There was no mortality in the series. Retrograde tibiopedal approach is an alternative option for managing peripheral arterial disease and CLI. This method offers another means of crossing lesions when antegrade access failed, and the intervention can be completed either in an antegrade or retrograde approach. As the retrograde approach does not impact access site, considered a feasible safe treatment alternative which increase the success rate of endovascular treatment.
