Tibiopedal and distal femoral retrograde vascular access for challenging chronic total occlusions: predictors for technical success, and complication rates in a large single-center cohort

Gerd Grözinger,Ulrich Grosse,Dominik Ketelsen,Klaus Brechtel,Mario Lescan,Roland Syha,Jan Hallecker,Konstantin Nikolaou,Christoph Artzner

doi:10.1007/s00330-020-07082-3

Gerd Grözinger, Ulrich Grosse + Show 7 more

Open Access

https://doi.org/10.1007/s00330-020-07082-3

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Abstract

ObjectiveTo evaluate the safety and effectiveness of tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion (CTO) in Rutherford stage III to VI peripheral arterial occlusive disease, and to determine factors that correlate with technical success.Material and methodsOne hundred seventy-one consecutive patients were included in this retrospective study. Rutherford stages were III, IV, and V/VI in 24%, 8%, and 67% of patients. Inclusion criteria were CTO at the superficial femoral (SFA), popliteal (PA), and/or below-the-knee (BTK) level, and a failed antegrade treatment followed by a distal retrograde approach. The numbers of occluded vascular levels (OVL), lesion length, degree of calcification, technical success rate, complications, and clinical outcome were noted.ResultsOVL were 1 in 72%, 2 in 20%, and 3 in 8% of patients. CTOs were longer than 20 cm in 45.6% of cases and showed severe calcifications in 50.3%. Target vessels for distal access were the distal SFA/PA in 17% and BTK in 83%. The overall technical success rate was 82%. Severe calcification decreased technical success (p = 0.01) despite lesion length and Rutherford stage. Clinical outcome improved in 123/152 patients with a significant increase of the median ABI (N = 158) from 0.53 (interquartile range 0.39 to 0.61) to 0.85 (0.59 to 1.03; p < 0.001). Complications were reported in 7.6% cases with 2.3% related to the distal vascular access.ConclusionThe tibiopedal and distal femoral retrograde access presents a safe and effective treatment option of CTOs at the thigh and/or BTK after a failed antegrade attempt improving clinical outcome. Technical success decreased with lesion’s degree of calcification.Key Points• Safety and effectiveness of the tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion.• Target lesion’s degree of calcification decreases technical success.• Complications related to the distal vascular access were rare.

Highlights

Peripheral arterial occlusive disease (PAOD) poses an expanding healthcare challenge due to a global increase in the aging population and a growing number of patients with diabetes [1,2,3]
Complications related to the distal vascular access were rare
Consecutive patients refer to patients with a failed antegrade approach and a target vessel suitable for distal puncture at the level of the distal thigh or lower leg, which accounts for 2.36% (171 of 7254) of all patients treated for peripheral arterial disease at the center

Summary

Introduction

Peripheral arterial occlusive disease (PAOD) poses an expanding healthcare challenge due to a global increase in the aging population and a growing number of patients with diabetes [1,2,3]. The techniques and dedicated material have improved, and technical success rates from 80% up to 100% for lesion crossing have been reported [8,9,10,11,12,13,14]. The application of this technique has been expanded to patients with lifestyle-altering claudication (Rutherford stage III) accompanied by an increase in the technical success rates of treatment [8, 9, 15]. Some concerns remain regarding the success rates and safety of this technique in patients with Rutherford category III [7]

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