Primary Retrograde Dorsalis Pedis Artery Single Access for Revascularization of Chronic Total Occlusion in Patients with Critical Limb Ischemia

Abstract

PurposeTo evaluate the dorsalis pedis artery (DPA) approach as a single access site for revascularization in patients with critical limb ischemia (CLI) when the femoral approach is hostile or unavailable. Materials and MethodsA retrospective review of patients who underwent iliac and femoropopliteal ipsilateral revascularization via a single access site from the DPA between January 2017 and February 2018 was performed. Fifteen limbs in 15 patients (10 men and 5 women; average age 72 y; range, 49–96 y) with CLI and unavailable femoral access were included. Patients were unsuitable candidates for a surgical bypass graft. Treated limbs were classified as Rutherford category 5 and 6 in 12 patients and category 4 in 3 patients. Treated occluded segments involved 2 iliac arteries, 12 femoropopliteal arteries, 1 bypass graft, and 2 posterior tibial arteries. Technical success was defined as recanalization of the occluded artery with residual stenosis < 30% and improvement in ankle-brachial index after 24 hours. Patients were followed for up to 13 months. Endpoints were freedom from reintervention and limb salvage for 1 year. ResultsTechnical success was achieved in 14 of 15 patients (93%). Stents were placed in 13 of 15 patients (86%). No complications were encountered immediately after the procedure. Median follow-up was 7.1 months (range, 1.4–13.5 mo). One patient was lost to follow-up. Reintervention was needed in 5 limbs after an average of 4.2 months. Limb salvage rate at 1 year was 83%. ConclusionsUsing the DPA as a single access could be a valuable approach when traditional access sites are unavailable for treating patients with CLI.