Endovascular recanalization of femoropopliteal occlusions continues to be one of the initial therapeutic strategies to treat this pathology.
The anterograde approach via the common femoral is the most frequently used. However, it is not always viable, especially in long occlusions with severe calcification or when the femoral artery cannot be reached. In these cases, the retrograde approach represents a safe and effective strategy.
The aim of this retrospective, single center study was to assess the safety, efficacy and feasibility of retrograde crossing of femoropopliteal occlusions with tibial access after failed anterograde approach.
Primary efficacy endpoint was retrograde crossing success rate. secondary efficacy endpoint was technical success rate. Primary safety endpoint was the rate of acute (≤30 days) access site-specific complications.
Secondary safety endpoints included the rate of major adverse cardiovascular events (MACE) at 30 days (30-day MACE) and the rate of acute (≤30 days) intervention-specific complications.
Primary feasibility endpoint was rate of successful cannulation and sheath introduction. Secondary feasibility endpoints included the cannulation time and the time for hemostasis.
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From 2015 to 2022 the study looked at 152 patients. Mean age was 74 and 50.7% were men. The most frequent clinical presentation was resting pain in 67.8% (Rutherford IV), followed by Rutherford III in 22.4% of patients. Mean lesion length was 25 cm, and 45% of cases presented PACSS calcification grade III followed by grade IV in 43%. The proximal tract of the anterior tibial artery was the most used (60.5%), and sheath inductor and cannulation (4Fr in 50.7%) were successful in all cases.
Rate of retrograde crossing of femoropopliteal occlusions was 94%. As regards Access site related complications within 30 days, these were found in 4.6% of patients. Specific complications associated to the intervention happened in 12.5% of cases. MACE rate was 3.3% and MALE rate (major adverse limb events) was 2%.
Conclusion
Retrograde crossing of femoropopliteal occlusions with tibial access after anterograde failed approach is feasible, safe and effective. It could be an interesting alternative to combine both these approaches. This calls for further prospective, randomized and multicenter studies with long term follow up.
Dr. Andrés Rodríguez.
Member of the editorial board of SOLACI.org.
Original Title: Endovascular treatment of femoro‐popliteal occlusions with retrograde tibial access after failure of the antegrade approach.
Reference: Roberto Minici MD et al Catheter Cardiovasc Interv. 2023;1–12.
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