3:36 PM Abstract No. 312 Primary versus secondary retrograde pedal access for lower extremity peripheral vascular disease

Abstract

Retrograde pedal access has been utilized with increasing frequency in patients who failed conventional femoral approach. Although routinely performed, there is limited data in its safety and efficacy, especially in patients with primary pedal access without previously failed femoral access. We report on patient outcomes with retrograde pedal access for lower extremity arterial recanalization and compare primary pedal access versus secondary pedal access after a failed femoral approach. Retrospective chart review was performed on patients who underwent pedal access with a minimum 6-month follow-up between February 2017 and February 2018. 51 patients were included, and charts were reviewed for the following: age, rutherford stage, comorbidities, technical and clinical success, procedural complications, hospitalization rates, and mortality. All interventions were classified as primary versus secondary (previously failed femoral approach). Of the 51 patients, 53 presenting complaints were noted: primary/recurrent ulcers (48.9%), rest pain (35.6%), claudication (17.8%), and gangrene (15.6%). All 51 patients were classified into Rutherford categories III (11.1%), IV (24.4%), V (60.0%), VI (2.2%). The target lesion was most commonly located in the anterior tibial artery (53.3%), followed by posterior tibial (40.0%), popliteal (35.6%), superficial femoral (17.8%), and dorsalis pedis artery (6.7%). The frequency of primary and secondary intervention was 28.9% (n = 13) and 71.1% (n = 32) respectively. No significant differences in complications, mortality, and hospitalization were noted between primary vs. secondary intervention. Additionally, technical success (primary– 100%, 13/13 vs. secondary– 90.6%, 29/32) were similar. Retrograde pedal access is an effective technique in patients with unsuccessful femoral approach and can be a primary approach in patients with advanced arterial disease.