Retrograde percutaneous tibial approach for complex infrainguinal occlusions in chronic limb-threatening ischemia after failed antegrade transfemoral approach

Abstract

Introduction: A significant proportion (20%) of patients with complex infrainguinal arterial occlusions cannot be recanalized using a conventional antegrade endovascular approach. Most of these patients will be poor candidates for open surgical reconstruction owing to the concomitant cardiovascular and pulmonary comorbidities or poor venous conduit. We present our experience using the percutaneous retrograde pedal approach for revascularization of infrainguinal arterial occlusions after failed conventional endovascular options. Materials and Methods: This is a retrospective observational study of all the patients admitted in our center from May 2019 to May 2021 for chronic limb-threatening ischemia with infrainguinal occlusive disease and attempted retrograde tibial approach after failed antegrade transfemoral approach. Procedural success was defined as residual stenosis of <30% after balloon angioplasty or stenting. Limb salvage was defined as freedom from major amputation during the follow-up period. Results: In a total of 20 patients managed with retrograde tibial approach, procedural success was achieved in 18 patients (90%). Limb salvage was achieved in 17 of the 18 patients who had procedural success during the follow-up period. One patient underwent below-knee amputation due to spreading infection. Conclusion: Retrograde tibial approach to recanalize infrainguinal arterial occlusions after failed traditional endovascular methods is safe and effective and should be advocated to avoid more invasive, time-consuming, and high-risk procedures as it offers high technical and procedural success rates with minimal complications.

Keywords

• chronic limb-threatening ischemia
• critical limb ischemia
• pedal access
• peripheral arterial disease
• retrograde tibial access
• tibiopedal approach