Should We Start Using the Retrograte Access in Critical Limb Ischemia?

Courtesy of Dr. Carlos Fava.

Peripheral vascular disease in lower limbs is on the rise. Antegrade recanalization is associated with amputation and death, and therefore contraindicated.

Nuevas estrategias en el territorio femoropoplíteo

For a while we have been using the retrograde access when classic revascularization is not possible.

Even though there is evidence in favor of this access, it is just a small series and very diverse groups of patients. In addition, this strategy requires a steep learning curve.

The study included 524 patients with peripheral vascular disease. 70% presented critical limb ischemia; 554 limbs.

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Mean age was 72, 63% were men, 62.5% were diabetic, 50% had kidney function deterioration and 5.7% were in dialysis.

The presence of total occlusions was 35.6% in femoropopliteal territory, 42.6% in infrapopliteal territory and 21.6% in both, with average length 19.4 cm.

Procedural success was 89%. Puncture related complications were 3.3%.

At 30 days, mortality was 21 patients (4%). They all presented critical limb ischemia, pseudoaneurysm 3.2% and surgery for bleeding or pseudoaneurysm 1.3%.

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At one year, freedom from target lesion revascularization and restenosis was 74.6% and 67.5% in those presenting intermittent claudication and 62.2% and 36% in those presenting critical limb ischemia respectively.

At four years, mortality was 24.5% and major amputation was 8.6%. Both events were significantly larger in patients presenting critical limb ischemia, as well as clinically driven target lesion revascularization.


Retrograde tibioperoneal access is safe for complex infrainguinal total occlusions after failed antegrade access. Puncture site complications are rare.

Courtesy of Dr. Carlos Fava.

Original title: Retrograde Tibioperoneal Access for Complex Infrainguinal Occlusions Short- and Long-Term Outcomes of 554 Endovascular Interventions.

Reference: Andrej Schmidt, et al. J Am Coll Cardiol Intv 2019;12:1714–26.

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