Outcomes of retrograde intervention for chronic lower extremity arterial disease at Hanoi Heart Hospital

Abstract

Background: Chronic lower extremity arterial disease, mostly caused by atherosclerotic etiology, has been increasing in recent years. Currently, there has been a shift in the treatment of chronic lower extremity arterial disease from open surgical treatment to endovascular intervention, even with complex TASC, C, D lesions.
 Objectives: Evaluate the results of retrograde intervention for chronic occlusive lesions of lower limb arteries. 
 Methods: From April 2021 to August, the cross sectional, descriptive study was carried out on 27 patients with lower limb artery disease, treated by retrograde intervention in Interventional Department, Hanoi Heart hospital. All patients were evaluated characteristics by clinical symptoms, ankle- brachial index and lesion characteristics before and after the intervention, complications, short -term results.
 Results: Patients with severe claudication: 70.4%, severe limb ischemia: 29.6%, the average ABI was 0.59. The majority of lesions belong to TASC II C and D (96.3%). Retrograde vascular access was ATA: 33.3%, PTA: 22.2%, popliteal artery: 14.8% , distal SFA: 7.4%, CFA: 22.2%. Vascular access under ultrasound guidance is 92.6%, under DSA: 7.4%. Subinimal guide wire: 74.1%, intraluminal guide wire 25.9%. Technical success was 100%. There were 21 cases (77.8%) with stent placement, 6 cases (22.2%) with balloon dilatation alone. The post-procedure complication was pseudoaneurysm at the puncture site (7.4%). Target lesion revascularization (TLR) rate after 1 month was 100%, after 6 months was 83.3%.
 Conclusions: Retrograde intervention to treat chronic occlusive lesions of lower extremity arteries is an effective, safe, and minimally invasive method. The "key" to performing retrograde intervention is distal vascular access.