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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 12/2016

01-12-2016 | Clinical Investigation

Routine Use of Surgical Retrograde Transtibial Endovascular Approach for Failed Attempts at Antegrade Recanalization of Chronic Peripheral Artery Total Occlusions

Authors: GangZhu Liang, FuXian Zhang, XiaoYun Luo, ChangMing Zhang, YaPing Feng, LuYuan Niu, Huan Zhang, Lu Hu, Hui Zhao, Long Cheng, MingYi Zhang

Published in: CardioVascular and Interventional Radiology | Issue 12/2016

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Abstract

Purpose

Our aim was to describe the technical aspects and clinical outcomes of an open surgical approach to retrograde transtibial endovascular therapy for recanalization of chronic total occlusions (CTOs) of peripheral arteries because of inability to acquire antegrade intravascular access across the occlusion.

Materials and Methods

Between January 2011 and May 2014, conventional antegrade revascularization failed in 15 limbs of 15 patients (11 males, 4 females) with complex CTOs. The mean age of the patients was 74 years (range 48–83 years). Five patients had severe claudication (Rutherford Category 3), and 10 patients had critical limb-threatening ischemia (Rutherford Categories 4–5). For each of these cases of antegrade failure, an open surgical exposure of the tibial or dorsalis pedis artery was used to allow a safe retrograde transtibial endovascular approach to recanalize the CTO.

Results

Surgical retrograde access from the tibial artery was achieved successfully in 14 of the 15 patients. In the 14 successful retrograde endovascular approaches, surgical retrograde transtibial access was achieved from the dorsalis pedis artery in 8 patients and from the posterior tibial artery in 6. The average time to obtain retrograde access was 5 min (range 2–11 min). No stenosis or occlusion occurred in the tibial or dorsalis pedis arteries used for the retrograde access sites during follow-up.

Conclusions

Routine surgical exposure can be a safe and an effective method for retrograde transtibial access to the more proximal occluded arterial segments in selected patients with CTO.
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Metadata
Title
Routine Use of Surgical Retrograde Transtibial Endovascular Approach for Failed Attempts at Antegrade Recanalization of Chronic Peripheral Artery Total Occlusions
Authors
GangZhu Liang
FuXian Zhang
XiaoYun Luo
ChangMing Zhang
YaPing Feng
LuYuan Niu
Huan Zhang
Lu Hu
Hui Zhao
Long Cheng
MingYi Zhang
Publication date
01-12-2016
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 12/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-016-1449-4

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