Retrograde Access for Lower Limb Revascularization

Objectives: To assess the efficacy and success of the retrograde approach as the first line for arterial revascularization or as an adjunct to the antegrade approach in patients with critical limb ischemia at a high-volume vascular institution. Methods: A prospective cohort study was performed to evaluate the success rate of using a retrograde approach to revascularize patients who had a failed previous attempt at antegrade angioplasty or as primary attempt if noninvasive imaging showing a patent pedal or popliteal artery. The approach was decided at the time by the interventionist who was doing the procedure. The access vessels used were the popliteal, posterior tibial and anterior tibial arteries. Under ultrasound guidance, access to the chosen artery was secured with 4–6 F sheath and distal access cocktail (heparin, verapamil, and nitroglycerin) used directly after gaining access. The method used to complete the intervention up to the external iliac artery. All patients have clinical and duplex scan follow according to the same pathway for antegrade angioplasty. Results: 32 patients with critical limb ischemia with multilevel stenoses and or occlusions had retrograde angioplasty performed. 75% patients had diabetes mellitus and 46% (15 of 32) patients had a failed previous attempt of antegrade angioplasty. 3 (9%) patients had both antegrade and retrograde access performed, with the retrograde wire snared. 7 (21%) had popliteal access, 17 (53%) had posterior tibial access, and 8 (25%) patients had the anterior tibial artery used as the primary access vessel. 21 of 23 (91%) patients were successfully revascularized with good results with two cases being abandoned, one no target vessel and one unable to re-enter proximal inflow. There were no periprocedure complications, but one patient developed pseudoaneurysm at the access site (injected with thrombin). Conclusion: This cohort showed that retrograde access in the right choice of patients can have an excellent success rate and should be considered as a primary access site or an adjunct to the antegrade approach.

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Artikel online veröffentlicht:
26. April 2021