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Updated: Jul 17, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Clinical feasibility of primary retrograde endovascular therapy via trans-ankle intervention: a retrospective
Hiromi Miwa1, Naoki Hayakawa2, Toshiki Tsurumaki2
1Department of Cardiovascular Medicine, Asahi General Hospital, Chiba, Japan. hiromi.n.saito@gmail.com.
Background:
Trans-ankle intervention (TAI) through retrograde distal access via below-the-knee and below-the-ankle arteries has been increasingly reported as an alternative approach for the treatment of femoropopliteal (FP) lesions. Although previous studies have described the procedural success of this strategy, its clinical feasibility and post-procedural outcomes remain insufficiently characterized.
Methods:
In this retrospective single-center study, the data from 33 patients with 36 FP lesions who underwent endovascular therapy (EVT) between January 2024 and January 2025 were analyzed. The primary endpoint was procedural success. The secondary endpoints were clinical worsening of lower-limb ischemia within 30 days, 1-year freedom from clinically driven target lesion revascularization (CD-TLR), and procedural complications. The risk of post-procedure access vessel occlusion was also investigated.
Results:
TAI was performed via access sites ranging from the anterior tibial artery (ATA) to the dorsalis pedis artery in all patients. Procedural success was achieved in all cases, and the rate of 1-year freedom from CD-TLR was 91.8%. All patients had FP lesions, including three cases up to the iliac artery. Forty-two percent was chronic total occlusion, and EVT of the ATA was required in 42% of the cases to establish the access route. Ten cases (27.8%) were approached via the occluded pre-ATA, and 15 (41.7%) required intervention to approach the vessel. The average number of pre-procedural and post-procedural below-the-knee artery runoff vessels was 2.4 and 2.75, respectively. No patients showed clinical worsening within 30 days. The risk factors for ATA occlusion were hemodialysis, ATA intervention, and approach via the occluded ATA.
Conclusions:
TAI may represent a feasible result, especially for selected FP lesions. Although no clinical worsening was observed, an increased risk of postoperative ATA occlusion existed in patients on hemodialysis and those with access site atherosclerosis requiring ATA intervention. However, in these high-risk populations, this limitation may potentially be overcome by an approach through the occluded ATA.
