Retrograde Tibiopedal Access for Chronic Limb-Threatening Ischemia

Abstract

Objective: The objective of the current study was to report single-center data concerning the efficacy, safety, and midterm outcomes of retrograde tibiopedal access, after failed antegrade attempts, for management of infrainguinal chronic total occlusions (CTOs) in patients with chronic limb-threatening ischemia (CLTI). Methods: This prospective, observational study was conducted between July 2016 and June 2019 and included 178 patients with infrainguinal CTO in whom a percutaneous tibiopedal access was attempted as a consequence of failed recanalization using an antegrade approach due to ostial lesions or failed re-entry. Results: The study reported access, crossing, and treatment success of 93.8%, 89.9%, and 88.8% of all tibiopedal access attempts, respectively. Primary, assisted primary, and secondary patency rates were 43.8% ± 3.9%, 64.2% ± 3.8%, and 71.7% ± 3.5% at 24 months, respectively. Kaplan–Meier analysis yielded an overall amputation-free survival of 71.1% ± 3.5% at 24 months. Conclusion: Retrograde tibiopedal access is an effective and safe approach as associated with high access, crossing, treatment success, and low complication rates. This approach is considered as a bailout technique during endovascular procedures in recanalization of infrainguinal CTOs, after failed antegrade attempts, in patients with CLTI.