Retrograde Group Research Articles

Antegrade Versus Continuous Retrograde del Nido Cardioplegia in the David I Operation

The efficacy of continuous retrograde del Nido cardioplegia for myocardial protection is still controversial. We hypothesised that antegrade and retrograde cardioplegia offer equivalent safety for myocardial protection in the David I procedure. We retrospectively reviewed 33 patients undergoing the David I operation with antegrade or retrograde del Nido solution from June 2014 to January 2016. The outcomes were compared. The follow-up was 1 month to 15 months. There was no hospital mortality or reoperation in both groups. Cardiopulmonary bypass, and aortic clamp times were similar. Troponin I level (TnI), creatine kinase level (CKMB), left ventricular ejection fraction (LVEF), ventilation times, intensive care unit (ICULOS) and hospital stay times (THLOS) were similar between the two groups. The lactate level was slightly higher (9.26±2.56 vs 7.17±1.58, p=0.01) in the antegrade group compared with the retrograde group. The incidence of heart block was higher (four patients) in the retrograde group (26.7% vs 0%, p=0.019). Only one patient (6.7%) required implantation of a permanent cardiac pacemaker. Antegrade and continuous retrograde del Nido cardioplegia can be used safely and effectively in the David I operation. The continuous retrograde del Nido cardioplegia is associated with a higher rate of temporary AV block which does not require permanent pacing, and a lower lactate level.

A prospective randomized comparison of contralateral snare versus retrograde gate cannulation in endovascular aneurysm repair

ObjectiveThe objective of this study was to compare snare vs the standard retrograde gate cannulation method during endovascular aneurysm repair to determine the most efficient technique and to evaluate whether time was affected by graft design or the surgeon's experience. MethodsThis was a prospective randomized study involving single-center elective endovascular aneurysm repairs. Patients were randomized to the snare or retrograde group in a 1:1 ratio. The initial method was attempted for 15 minutes; if it was unsuccessful, the team switched to the alternative technique for an additional 15 minutes. The protocol continued until success was achieved. Data collected on demographic, anatomic, and procedural factors were analyzed for statistically significant differences. ResultsA total of 101 patients were included. Average age was 75.3 years, and 82% were male; 49 patients were randomized to snare and 52 to retrograde cannulation. The groups were overall similar. Median cannulation times were 3.9 minutes for the snare and 2.7 minutes for the retrograde technique (P = .13). The snare group attempts were successful within the initial 15-minute period in all but one patient (98% success). In the retrograde group, 5 of the 52 (10%) crossed over to snare. This difference did not reach statistical significance (P = .11). A difference was seen in the extremes of cannulation times. The surgeon's experience and graft design were not found to have significant effects on cannulation times. Further analysis of the retrograde group patients with long cannulation time found a relative breakpoint at the 5-minute mark. In those exceeding this time mark, the chance of eventual cannulation within 15 minutes dropped to 67%. In this group, median time to cannulation was 12.2 minutes for retrograde compared with 7.1 minutes for snare after crossover. ConclusionsGate cannulation was successful using both methods with no statistical difference between the two in median time. Retrograde cannulation was found to be more likely to have short times. If cannulation by retrograde technique had not been achieved in the first 5 minutes, the chances of eventual success dropped significantly, and crossover to snare was more efficient. This finding suggests that one should consider an alternative method of gate cannulation if it has not been accomplished within this time.

Incidence and impact on midterm outcome of intimal versus subintimal tracking with both antegrade and retrograde approaches in patients with successful recanalisation of chronic total occlusions: J-PROCTOR 2 study.

The aim of this study was to assess the incidence and impact on midterm outcomes of intimal versus subintimal tracking with both antegrade and retrograde approaches in patients undergoing successful percutaneous coronary intervention for chronic total occlusion (CTO). In 2012, a total of 1,573 CTO cases from 30 hospitals were enrolled in the Japanese CTO registry. Successful guidewire crossing was performed in 1,411 cases (89.7%). Among them, the guidewire penetration position was clearly identified using intravascular ultrasound (IVUS) imaging in 352 cases, and clinical follow-up at 12 months was performed in 323 cases. These 323 cases were enrolled in this retrospective study: 242 cases were treated with the antegrade approach (antegrade group) and 81 cases were treated with the retrograde approach (retrograde group). The endpoint of this study was target vessel revascularisation (TVR) and major adverse cardiac events (MACE) at 12-month follow-up. Subintimal tracking occurred more frequently in the retrograde group (11.6% vs. 30.9%, p<0.01). TVR was more frequent in the subintimal tracking group in the retrograde group (7.1% vs. 16.0%, p=0.03) but not in the antegrade group (2.8% vs. 3.6%, p=0.99). Although the occlusion length was similar, the subintimal tracking group required a longer stent length compared to the intimal tracking group in the retrograde approach (59.7±24.4 mm vs. 74.0±24.4 mm, p<0.01). Subintimal tracking was more frequent in the retrograde approach. Intimal tracking should be recommended in the retrograde approach to reduce stent length and to improve follow-up outcomes.

Retrograde Approach is as Effective and Safe as Antegrade Approach in Contemporary Percutaneous Coronary Intervention for Chronic Total Occlusion: A Taiwan Single-Center Registry Study.

In percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), most experts regard the antegrade approach as the default initial strategy, reserving the retrograde approach for reattempts following antegrade failure. In this study, we aimed to compare the efficacy and safety between the antegrade and retrograde approaches in CTO PCI. Between 2012 and 2013, patients that underwent 321 consecutive attempts by high-volume operators (> 75 total CTO PCI cases during the period) in a tertiary university-affiliated hospital were enrolled. The antegrade approach was used in 152 patients, and retrograde in 169 patients. The duration of occlusion was significantly longer and the J-CTO score higher in the retrograde group. Technical success was achieved in 148 patients of the antegrade group (97.4%), and 163 patients in the retrograde group (96.4%) (p = 0.75). A major procedural complication occurred in 3 patients of the antegrade group (2.0%) and in 6 patients of the retrograde group (3.6%) (p = 0.51). In-hospital major adverse cardiac events (MACE) rates (antegrade 0.7%, n = 152; retrograde 0.6%, n = 169) were comparable. The procedure and fluoroscopy times were significantly longer, with more radiation exposure and contrast medium consumption, in the retrograde group. In the retrograde group, similar success, procedural complication and in-hospital MACE rates were achieved in the 3 collateral subgroups. In selected cases and with highly experienced operators, retrograde approach in CTO PCI is as effective and safe as antegrade approach at the expense of longer procedure time, more radiation exposure and contrast medium consumption. For retrograde approach, either septal, epicardial or AV groove collaterals can be used with similarly success, complication and in-hospital MACE rates.

Comparison of Hemodynamic Response and Complications in Patients with Difficult Airway Using Two Techniques-Retrograde and Fibreoptic Intubation

Objective: The Aim of this study was to identify the hemodynamic response and success rate to awake retrograde endotracheal intubation (REI) and fiberoptic bronchoscope (FOB) assisted endotracheal intubation in difficult airway situation and to validate whether the REI can attenuate the hemodynamic response to tracheal intubation compared with the FOB assisted intubation. Design: Randomized Prospective Study. Methods: 64 adults, ASA I-II scheduled for elective surgery requiring endotracheal intubation were randomly allocated to either the awake REI group (n=32) or the FOB group (n=32). Non-invasive blood pressure (NIBP), heart rate (HR) and Spo2 were recorded. Time taken for intubation and success rate of intubation during the observation was also recorded. Results: During awake intubation, the magnitude of change of both NIBP and HR was greatest in Group REI as compare to Group FOB. Time taken for intubation and success rate were better in FOB group, while complication like airway trauma was higher in awake retrograde intubation group (REI). Conclusions: Awake Endotracheal intubation using FOB and REI in adult may cause increases in MAP and HR. However we observed maximum increase in heart rate and MAP occurred at the end of intubation in REI group than FOB, while time taken for intubation were lesser and success rate of intubation were superior in FOB as compare to REI group.

眼动脉逆行与顺行介入治疗视网膜中央动脉阻塞的对比观察

目的：对比眼动脉逆行和顺行介入治疗CRAO的疗效。方法：平均发病时间22h的CRAO者50只眼，分为眼动脉逆行介入组26眼，眼动脉顺行介入组24眼，均在DSA下采用尿激酶40万U、罂粟碱30mg进行溶栓治疗，最后从DSA，FFA，视力的改变进行分析。结果：逆行、顺行治疗后均见眼动脉及其分支增粗循环加快和眼环显著，FFA有效率相似，视力改善相似，在介入及随访过程中均无全身、眼部合并症。结论：眼动脉逆行和顺行介入溶栓治疗CRAO均可取得较好的疗效，逆行安全性高。 Objective: To evaluate the clinical efficiency of retrograde as a novel method and interventional therapy for central retinal artery occlusion (CRAO). Method: CRAO 50 eyes with average onset time of 22 h, were divided into ophthalmic artery retrograde group with 26 eyes, ophthalmic artery intervention group with 24 eyes. All eyes were used urokinase 400000U, papaverine 30 mg under DSA for thrombolysis treatment, and then DSA, FFA, vision changes were analyzed. Results: Retrograde and intervention treatment were found enlargement of ophthalmic artery and its branches, and eye ring accelerated circularly. FFA showed the efficient change and vision im-provement are similar in both groups, and there are no body and eye complications occurred in the process of intervention and follow-up. Conclusion: Ophthalmic artery retrograde and interventional thrombolysis therapy for CRAO can obtain same effect, and the former as a developed novel ophthalmic artery retrograde intervention method showed high safety.

A Comparative Evaluation of Apical Seal Associated with Ultrasonic Retrograde Cavities Filled with Bioactive Material (In Vitro Study)

Background: The aim of this study was to evaluate and compare the apical microleakage around retrograde cavities prepared with ultrasonic technique and filled with (Biodentine™) Materials and methods: 40 extracted single rooted human permanent maxillary teeth with mature apices were selected. The roots were prepared chemo-mechanically using k-files with crown-down technique and then obturated with lateral condensation gutta-percha technique. Teeth were divided into four main groups according to the cavity preparation method either manual or ultrasonic technique: Group A (n=10): A class I retrograde cavity at root end was prepared with traditional handpeice equipped and placement of Biodentine with manual condensation. Group B (n=10): A class I retrograde cavity at root end was prepared with Piezoelectric ultrasonic device equipped with ultrasonic tip with only manual compaction of the material. Group C (n=10): traditional handpeice and placement of Biodentine using both manual compaction and 5 second ultrasonic activation. Group D (n=10): Piezoelectric ultrasonic device and placement of Biodentine with both manual compaction and 5 second ultrasonic compaction. The teeth were immersed in 1% aqueous Methylene blue dye for 72 hr. Then they were sectioned longitudinally with a diamond disc and the depth of dye penetration was examined under high magnification 20X. Results: Statistical analysis showed a highly significant difference in microleakage among the tested groups in which Piezoelectric technique has proved superiority in retrograde cavity preparation and compaction of Biodentin when dye penetration scores were compared. So microleakage was highest with cavities prepared with handpeice and manual application of retrograde material group A (2.73±0.39) followed by microprepared cavities group C (1.86±0.16), and it was lowest with ultrasonically-prepared cavities group B (1.09±0.28) and group D (0.26±0.19). Conclusion: ultrasonic preparation produced significantly less microleakage than conventional method. Also less microleakage was observed with ultrasonic compaction of Biodentin when compared with conventional method of compaction.

A Prospective Randomized Comparison of Contralateral Snare Versus Retrograde Gate Cannulation in Endovascular Aneurysm Repair

The objective of this study was to compare contralateral snare vs retrograde gate cannulation during endovascular aneurysm repair to determine the most efficient technique and to evaluate whether time was affected by graft design or the surgeon's experience. This is an Institutional Review Board-approved prospective randomized study involving single-center elective endovascular aneurysm repairs. Patients were randomized to snare or retrograde in a 1:1 ratio. The initial method was attempted for 15 minutes; if it was unsuccessful, the team switched to the alternative technique for an additional 15 minutes. The protocol continued until success was achieved. Data collected on demographic, anatomic, and procedural factors were analyzed for statistically significant differences. A total of 101 patients were included. Average age was 75.3 years, and 82% were male. Forty-nine patients were randomized to snare and 52 to retrograde. The groups were overall similar (Table I). Mean cannulation times were 3.9 minutes for snare and 2.7 minutes for retrograde (P = .13). The snare group attempts were successful within the 15-minute period in all but one patient (98% success). In the retrograde group, 5 of the 52 (9.6%) crossed over to snare. This difference did not reach statistical significance (P = .11). A difference was seen in the extremes of cannulation times (Table II). The surgeon's experience and graft design were not found to have significant effects on cannulation times. Further analysis of the retrograde group patients with long cannulation times found a relative breakpoint at the 5-minute mark. In those exceeding this time, the chance of success in 15 minutes dropped to 67%. In this group, median time to cannulation was 12.23 minutes for retrograde compared with 7.12 minutes for snare after crossover. Gate cannulation was successful using both methods with no statistical difference between the two in median time. Retrograde was found to be more likely to have short times. If cannulation by retrograde technique had not been achieved in the first 5 minutes, the chances of eventual success dropped significantly and crossover to snare was more efficient. This finding suggests that one should consider an alternative method of gate cannulation if it has not been accomplished within this time.Table IComparison of demographic, anatomic, and procedural factors in snare vs retrograde patientsAll patients (N = 101)Snare (n = 49)Retrograde (n = 52)P valueAge, years75.3 ± 8.074.6 ± 7.575.9 ± 8.4.44Male82 (81.2)38 (77.6)44 (84.6).36BMI28.3 ± 4.928.5 ± 5.328.1 ± 4.5.67Implanting physician years10.7 ± 6.111.0 ± 5.910.5 ± 6.3.69Contralateral gate.31 Left78 (77.2)40 (81.6)38 (73.1) Right23 (22.8)9 (18.4)14 (26.9)Neck angulation10 (0, 22.5)10 (0, 31)10 (0, 20).26Iliac tortuosity.33 Mild44 (43.5)18 (36.7)26 (50.0) Moderate48 (47.5)27 (55.1)21 (40.4) Severe9 (8.9)4 (8.2)5 (9.6)Rotational orientation.34 Anterior92 (91.1)46 (93.9)46 (88.5) Posterior9 (8.9)3 (6.1)6 (11.5)Endograft device.56 Cook Zenith17 (16.8)9 (18.4)8 (15.4) Gore Excluder42 (41.6)21 (42.9)21 (40.4) Medtronic Endurant40 (39.6)19 (38.8)21 (40.4) TriVascular Ovation2 (2.0)0 (0)2 (3.9)Aortic diameter at gate orifice, cm5.0 (4.2, 5.6)4.8 (4.2, 5.5)5.1 (4.5, 5.6).33Distance from aortic bifurcation to gate orifice, cm3.3 (2.1, 4.2)2.9 (2.2, 3.4)3.6 (2.1, 4.5).072Diameter of aortic bifurcation3.2 (2.6, 3.7)3.1 (2.6, 3.5)3.3 (2.8, 3.7).52AO lumen at gate orifice3.2 (2.6, 3.9)2.9 (2.4, 3.5)3.4 (2.9, 4.2).006BMI, Body mass index.Continuous data are presented as mean ± standard deviation or median (25th, 75th percentile), and categorical data are presented as number (%). Open table in a new tab Table IIComparison of cannulation times and overall success in snare vs retrograde gate accessAll patients (N = 101)Snare (n = 49)Retrograde (n = 52)P valueSuccessful cannulation95 (94.1)48 (98.0)47 (90.4).11Cannulation time, minutes3.5 (1.5, 6.1)3.9 (2.2, 6.1)2.7 (1.1, 6.7).13Cannulation <1 minute13 (12.9)2 (4.1)11 (21.2).010Cannulation <2 minutes33 (32.7)11 (22.5)22 (42.3).033Cannulation ≥15 minutes7 (6.9)1 (2.0)6 (11.5).060Fluoroscopy dose, total mGy44 (21, 110)47 (25, 74)43 (15, 187).91Adverse event1 (1.0)0 (0)1 (2.0)1.00Continuous data are presented as median (25th, 75th percentile), and categorical data are presented as number (%). Open table in a new tab

Intramedullary Screw Fixation for Clavicle Shaft Fractures: Comparison of the Anterograde versus the Retrograde Technique

Background: The purpose of this study was to investigate the difference between two nailing approaches of intramedullary screw fixa-tion, the retrograde nailing versus the anterograde nailing, on the radiological and clinical outcomes in patients with clavicle shaft fractures.Methods: From April 2002 to August 2014, we enrolled a total of 22 patients with clavicle shaft fractures to participate in this study. Twelve patients received retrograde intramedullary nailing and 10 received anterograde nailing. The average duration of follow-up was 12 months. In all the patients, we took follow-up radiographs of the anteroposterior and the axial views to assess the postoperative ra-diological outcomes. We measured the visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and the range of motion (ROM). Results: Clinically, we did not find a statistically significant difference in the retrograde group and the anterograde group in terms of the duration to bone union, the VAS score the ASES score and the ROMs. Radiologically, we found that the difference in the clavicle short-ening of the affected arm and the unaffected arm did not show a statistically significant difference at the immediate postopera- tive assessment. we found that the difference in the clavicle shortening of the affected arm between the immediate postoperative and the final follow-up value did not show a statistically significant difference. Conclusions: We found that both the retrograde nailing and the anterograde nailing gave a favorable outcome for clavicle shaft frac-tures. Although we saw evidence of clavicle shortening after intramedullary screw fixation, this was not a factor that influenced clinical outcome.(Clin Shoulder Elbow 2016;19(1):8-14)Key Words: Fracture; Clavicle; Anterograde; Retrograde

Current Retrograde Approach Is Unfavorable to Long-Term Clinical Outcomes after Percutaneous Coronary Intervention for Chronic Total Occlusion.

Surgeons currently use two different wire-based approaches to recanalize coronary chronic total occlusion (CTO): antegrade and retrograde. It has been demonstrated that the retrograde approach has improved the procedural success rate, but it remains unclear whether the retrograde approach is better than the antegrade approach for the long term. In this study, we enrolled a total of 187 patients with a diagnosis of CTOs. We evaluated the baseline characteristics of these patients and performed percutaneous coronary intervention to treat their problems by using either antegrade or retrograde approaches and different techniques in both groups. In the antegrade approach, we used three techniques: single wire, parallel wire, and side branch. The techniques in retrograde included kissing wire, controlled antegrade and retrograde subintimal tracking (CART), and reverse CART. We found that the antegrade and retrograde groups had similar baseline characteristics, with a few minor differences. Most importantly, we found that within 1 yr of the recanalizing procedure, the restenosis rate and major adverse cardiac event rate of the retrograde group were significantly higher compared to the antegrade group. We conclude that the retrograde approach may not be as beneficial as the antegrade approach for long-term clinical outcomes.

Does retrograde tibial tunnel drilling decrease subchondral bone lesions during ACL reconstruction? A prospective trial comparing retrograde to antegrade technique

BackgroundThe main goal of this study was to assess iatrogenic subchondral bone lesions following three different anterior cruciate ligament (ACL) reconstruction techniques and their association with early postoperative pain. MethodsA multicenter prospective comparative study was conducted in 2012. Each center performed a specific ligamentoplasty technique: two used retrograde and the other antegrade tibial tunnel drilling. Peri- and postoperative analgesia and systematic early postoperative magnetic resonance imaging (MRI) protocols were standardized. The main assessment criterion was tibial subchondral lesions (microfractures or bone oedema) on MRI during the first postoperative week. Secondary criteria were the assessment of postoperative pain for two days using a Visual Analogical Scale (VAS 0–10) and consumption of analgesics. ResultsForty-three patients were included in three centers, 15 in the “antegrade group” and 28 in the “retrograde group”, mean age is 32.5±9.1years, 14 women/29 men. All included patients underwent postoperative MRI. There were no subchondral tibial microfractures, but oedema was significantly more frequent in the antegrade group (p=0.0001). Tibial subchondral oedema was correlated to greater early postoperative pain (p=0.01). Multivariate analysis identified tibial tunnel diameter as an independent factor of early postoperative pain. The smaller the tibial tunnel diameter, the greater the mean early postoperative pain (≤8mm (18 patients) 3.4±1.5 vs. >8mm (25 patients) 1.8±1.7, p=0.004) and the more frequent the presence of edemas (10/18 vs. 2/25, p=0.001). ConclusionThe present clinical study confirmed the benefit of retrograde tibial tunnel drilling for tibial subchondral bone lesions and showed a correlation between these lesions and early postoperative pain. Level of evidenceII; therapeutic study — prospective cohort study.

Long-term MACCE Rate after Retrograde Compared to Antegrade Recanalization of Chronic Total Coronary Occlusions

Background: The recanalization success rate of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be increased by the retrograde approach. However, the long-term outcome of patients undergoing retrograde procedures is unknown. Aim: We aimed to evaluate the long-term MACCE (major adverse cardiac and cerebrovascular event) rate (death, myocardial infarction, coronary artery bypass surgery and stroke) in patients after retrograde versus antegrade CTO-PCI. Methods and results: In a prospective single center study from January 2008 to June 2012, 396 consecutive patients with CTO´s (≥ 3 months old) were enrolled. Mean age was 63.4 ± 10.3 years, 86.4% were male. The recanalization success rate of the total patient cohort was 88.6%. The retrograde PCI, only attempted after a failed antegrade intervention, was performed in 18% (n = 71) of patients. Long-term MACCE rate (mean follow up 2.3 ± 1.6 years) was significantly higher in the unsuccessful compared to the successful CTO-PCI group (23.1% versus 9.4%, p = 0.01) and this was also the case in the subgroup of antegrade CTO-PCI. In the retrograde subgroup, however, procedural success had no impact on outcome. As a possible explanation for this surprising finding, patients with unsuccessful retrograde CTO-PCI had a significantly better collateral connection compared to patients with an unsuccessful antegrade approach. Conclusions: Long-term MACCE rate after unsuccessful recanalization was significantly higher which was driven by a higher MACCE rate after unsuccessful versus successful antegrade approach. In contrast, procedural success in the retrograde group had no impact on outcome.

Retrograde laparoscopic resection of left side of the liver: a safe and effective way.

The safety and feasibility of retrograde laparoscopic resection of the left side of the liver. Ninety-three laparoscopic left hepatic lobe cases were selected between August 2010 and August 2014 from our institution. A retrospective cohort study was performed between the antegrade partial hepatectomy group (47 cases; dissection from the first porta hepatis to the second) and the retrograde partial hepatectomy group (46 cases; dissection from the second porta hepatis to the first), to compare the length of time needed for resection, the amount of bleeding, post-operative time in the hospital, and the incidence of major complications, such as bile leakage, abdominal abscess, and post-hepatectomy hemorrhage. All of the cases had a successful laparoscopic partial hepatectomy without the need for an intraoperative blood transfusion. Patients were able to ambulate on post-operative day 1 and tolerated a liquid diet on post-operative day 1 or 2. There were no statistical differences of post-operative hospital length of stay or incidence of major complications between the two groups. Both duration of resection and the amount of bleeding were less in the retrograde group than of those in the antegrade group, due to the lower incidence of hepatic vein injury in the retrograde group. Occlusion of both the inflow and outflow hepatic vessels combined with retrograde hepatectomy from the second porta hepatis to the first, demonstrated less hemorrhage and lower incidence of hepatic veins injury during laparoscopic partial hepatectomy.

Retrograde versus antegrade intramedullary nailing for femoral fractures: a meta-analysis of randomized controlled trials

Objectives:To conduct a meta-analysis of randomized controlled trials assessing the effect on clinical outcomes of intramedullary nailing for femoral fractures via a retrograde or antegrade approach.Data sources:Randomized controlled trials using PubMed, Embase, and the Cochrane Library databases.Study selection:We used the following search terms with no language or study type restrictions: femoral shaft fractures, internal fixation, treatment outcome, intramedullary nailing, and retrograde or antegrade approach.Data extraction:Two independent authors extracted the data and we assessed the quality of the included studies based on Jadad score; allocation concealment; similarity of baseline characteristics; eligibility criteria; blinding; completeness of follow-up; and intention-to-treat analysis. Our primary outcome measure was the union rate and the secondary outcome measures were nonunion, knee pain, and heterotopic ossification. A total of 240 patients from three randomized controlled trials were included.Data synthesis:Risk ratios (RRs) and 95% confidence intervals (CIs) were computed for dichotomous variables, and weighted mean differences and 95% CIs for continuous variables. Heterogeneity among studies was assessed using the I 2 statistic, with I 2 > 50% considered significant. If heterogeneity was not significant, a fixed effects model was chosen to assess the overall estimate. Otherwise, a random effects model was used. We used Egger’s regression asymmetry test and Begg’s adjusted-rank correlation to assess publication bias.Conclusions:Both retrograde and antegrade intramedullary nailing produced high union rates. We found no significant difference in union rate between the retrograde nailing group and the antegrade nailing group for femoral fractures (RR 1.02, 95% CI: 0.94–1.11, p = 0.59, I 2 = 0%).

Retrograde Versus Antegrade Femoral Bone Graft Harvesting Using the Reamer–Irrigator–Aspirator

To compare retrograde versus antegrade femoral bone graft harvesting using the reamer-irrigator-aspirator system to determine whether there was any difference in intraoperative, postoperative, or patient outcome variables. Retrospective cohort study. Urban Level I Trauma Center. Ninety-four (62 antegrade and 32 retrograde procedures) consecutive adult patients who underwent femoral autologous bone graft harvesting using the Synthes reamer-irrigator-aspirator system between April 2008 and March 2013. Amount of bone graft, perioperative fractures or other complications, and postoperative hip and/or knee pain. There was no significant difference between demographic or medical comorbidities between the groups. There was no significant difference in the side of the graft harvest, graft volume, hospital length of stay, or the ability to ambulate on postoperative day 1. There was a significantly increased incidence of iatrogenic fracture or prophylactic nailing with antegrade reaming (4 vs. 0, P = 0.01). Average length of follow-up was 500 (range, 20-1477) days for the antegrade group and 378 (range, 19-706) days for the retrograde group. The antegrade group had a nonsignificant increased incidence of hip pain (8.1% vs. 3.1%, P = 0.66), and the retrograde group had a significantly higher incidence of knee pain (15.6% vs. 1.6%, P = 0.02) at 6-month follow-up. Neither hip nor knee complaints were present at final follow-up. No cases of delayed femur fracture, infection, or abductor and/or antalgic gait involving the donor extremity were seen at final follow-up. This study provides support to the safety of femoral bone graft harvesting using both antegrade and retrograde techniques. Both techniques provide reliable, high-volume, nonstructural autologous bone graft with minimal associated morbidity. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Recanalisation of coronary chronic total occlusion by retrograde approach: the first experience in Poland.

The effectiveness of revascularisation procedures of coronary chronic total occlusion (CTO) has been improved by the introduction of retrograde approach. This study compared the outcomes of CTO revascularisation in a single centre in Krakow, Poland using antegrade and retrograde approach. From January 2011 to September 2013, 150 patients underwent 159 procedures for percutaneous revascularisation of CTO of 153 vessels. Of the 159 procedures, 124 (78%) were performed using an antegrade approach and 35 (22%) using a retrograde approach. All patients were symptomatic, with mean CCS class (2.3 ± 0.6 vs. 2.1 ± 0.7, p = 0.9), mean age (59.2 ± 8.3 vs. 62.6 ± 9.9 years, p = 0.067), and mean number of males (81.3% vs. 81.8%, p = 0.9) similar in the retrograde and antegrade groups, respectively. Most patients in both groups had ejection fraction (EF) ≥ 50% (84.4% vs. 74.4%, respectively). Occlusions assessed according to the J-CTO score showed that 82.9% and 56.4%, respectively, were rated as difficult or very difficult (p < 0.01). Overall procedural success rate was 88.2%, 87.9% in the antegrade, and 74.3% in the retrograde group. Complication rates were low and similar in two groups. However, the retrograde approach was associated with a longer mean fluoroscopy time (47.8 ± 19.6 vs. 19.3 ± 10.0 min, p < 0.00001) and higher volume of contrast fluid (494.6 ± 142.4 vs. 291.9 ± 118.1 mL, p < 0.00001). Using novel equipment with adequate experience allowed high rates of successful revascularisation. The retrograde technique for CTO revascularisation showed good overall success and was safe.

Antegrade versus retrograde approach to interlocking nail fixation of femoral diaphyseal fractures: Is there difference in time to union?

Antegrade reamed interlocked intramedullary nailing is the treatment of choice forfemoral diaphyseal fractures. More recently, retrograde intramedullary nailing of the femur has been seen as a viable alternative to the antegrade nail. This was a prospective comparative study. Consecutive patients were placed alternately into a study group (retrograde nailing) and a control group (antegrade nailing) in a ratio of 2:1 i.e two retrograde nailing for every antegrade nailing. Forty one fractures had interlocking intramedullary fixation via the retrograde approach (study group), while the control group consisted of twenty fractures that had fixation via the antegrade approach. All were followed up for a minimum period of nine months (range of nine to twenty-four months). The mean duration of surgery in the retrograde group was 157.07minutes and 137.40 minutes in the antegrade group (p=0.093). The mean duration to fracture union was 16.98±4.71 weeks in the retrograde group and 15.80±5.43 weeks in the antegrade group (p = 0.388). There was no incidence of non-union in the two groups. Retrograde approach compares favourably with antegrade approach for intramedullary interlocking nail fixation of diaphyseal femoral fracture in adults with respect to time of fracture healing.

Long-term outcomes of successful chronic total occlusion percutaneous coronary interventions using the antegrade and retrograde approach.

To compare long-term clinical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using the retrograde and antegrade approach. There is limited long-term clinical outcomes data on the retrograde approach to CTO PCI. We performed a retrospective analysis of the long-term clinical outcomes of 193 consecutive patients who underwent successful CTO PCI at our institution between March 2008 and December 2011. Mean age was 63.6 ± 8.3 years. The target vessel was right coronary artery in 52.6%, left anterior descending artery in 24.5% and circumflex in 21.4% of cases. The retrograde approach was used in 41 patients (21.2%). The mean stent length was longer in the retrograde group (83 ± 32 vs. 64 ± 32 mm, P = 0.001). Two major procedural complications occurred, both in the retrograde group (P = 0.012). During a median follow-up of 2.0 years compared to the antegrade CTO PCI group, patients who underwent retrograde CTO PCI were more likely to undergo target lesion revascularization (TLR) (45.6% vs. 25.7%, P = 0.006). No significant difference was observed in the incidence of all-cause mortality, myocardial infarction, non-target vessel revascularization, or coronary artery bypass graft surgery between the 2 groups. On multivariate analysis, stent length was the only independent predictor of TLR during follow-up. Retrograde CTO PCI was associated with higher incidence of TLR, but similar incidence of death and myocardial infarction compared to antegrade CTO PCI. These findings likely reflect the higher complexity of CTO lesions treated with the retrograde approach.

Effects of Antegrade and Retrograde Machine Perfusion Preservation on Cardiac Function After Transplantation in Canines

IntroductionMost studies investigating machine perfusion preservation for heart transplantation perfuse through the aortic root (antegrade), but the coronary sinus (retrograde) is a potential option. We hypothesized that retrograde machine perfusion provides better functional protection than static storage, while avoiding the potential irregular perfusion seen when aortic insufficiency occurs with antegrade perfusion. Materials and MethodsEighteen canine donor hearts were arrested, procured, and stored in modified Celsior solution for 4 hours by using either static storage at 0°C to 4°C (n = 6) or machine perfusion preservation at 5°C via the aortic root (antegrade, n = 6) or coronary sinus (retrograde, n = 6). Lactate and myocardial oxygen consumption were measured in perfused hearts. Hearts were reimplanted and reperfused for 6 hours with hourly function calculated by using the preload recruitable stroke work (PRSW) relation. Myocardial water content was determined at the end of the experiment. ResultsStorage lactate levels and myocardial oxygen consumption were comparable in both perfused groups. The PRSW was increased immediately after bypass in the antegrade group (120.6 ± 19.1 mm Hg) compared with the retrograde (75.0 ± 11.3 mm Hg) and static (78.1 ± 10.5 mm Hg) storage groups (P < .05). At the end of reperfusion, PRSW was higher in the retrograde group (69.8 ± 7.4 mm Hg) compared with the antegrade (40.1 ± 6.8 mm Hg) and static (39.9 ± 10.9 mm Hg) storage groups (P < .05). Myocardial water content was similar among groups. ConclusionsBoth antegrade and retrograde perfusion demonstrated excellent functional preservation, at least equivalent to static storage. Initial function was superior in the antegrade group, but the retrograde hearts displayed better function late after reperfusion. Neither perfused group developed significant edema. Machine perfusion preservation is a promising technique for improving results of cardiac transplantation.

Parotidectomy for parotid gland tumor using a retrograde approach from the peripheral branches of the facial nerve

There are two techniques for excising a parotid gland tumor. The first technique is the anterograde approach, and the second is the retrograde approach. Although the anterograde approach has generally been adopted, the retrograde approach may be useful depending on the identification and dissection of the facial nerve and the localization of the tumor. We reviewed 35 patients who were surgically treated with a parotidectomy using the retrograde approach between 2002 and 2012 at Tenri Hospital. We also reviewed the clinical records for evidence of temporary or definitive injury to the facial nerve. In cases where the identification of the main nerve trunk was expected to be difficult, the parotidectomy was performed using the retrograde approach guided by the mandibular branch. In cases where a tumor was located in the marginal region of the parotid gland, the retrograde approach was guided by the mandibular branch or the zygomatic branch. Of the 35 patients, 17 underwent the retrograde approach guided by the mandibular branch and 18 underwent this approach guided by the zygomatic branch. The mean surgical time and amount of bleeding using the retrograde approach were 70.7 minutes and 33.9 g, respectively. Two of the 35 patients in the retrograde group exhibited a temporary facial deficit.