Endovascular retrograde recanalization in Asian critical limb ischaemia patients

Tay, Jia Sheng; Ching, Siok Siong; Tan, Yih Kai; Kum, Steven

doi:10.1111/ans.13649

Cited by 11 publications

(19 citation statements)

References 11 publications

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“…The presented data show that retrograde access is an additional safe option to enhance the success of lesion crossing in complex cases of CTO with only four complications (4/171 procedures; 2.3%) related to the distal puncture. The additional distal puncture and subsequent successful treatment may omit surgery with its associated morbidity and mortality; furthermore, PTA may be the only viable treatment option before amputation [8][9][10][11][23][24][25][26]. Our data strengthen the conclusion of the safety aspects for this technique by originating from the largest patient cohort so far supported by good clinical shortterm data.…”

Section: Discussionsupporting

confidence: 73%

“…Among a growing number of dedicated devices for CTO revascularization [5,6], a retrograde approach with tibiopedal access is an increasingly used strategy [5,7]. Since its first usage, 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].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Grözinger¹,

Hallecker

Grosse³

et al. 2020

Eur Radiol

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Objective To 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 methods One 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. Results OVL 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. Conclusion The 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.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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

Grözinger¹,

Hallecker

Grosse³

et al. 2020

Eur Radiol

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“…In a retrospective review by Tay et al 9 ) , 40 patients with CLI with chronic total occlusions (CTO) had endovascular retrograde intervention in Singapore. Retrograde SAFARI technique in those with chronic total occlusions was safe and feasible, with a high technical success and limb salvage rates.…”

Section: Appraisal Of Aha/acc Guideline Statements and The Appadc Recmentioning

confidence: 99%

Asia-Pacific Consensus Statement on the Management of Peripheral Artery Disease: A Report from the Asian Pacific Society of Atherosclerosis and Vascular Disease Asia-Pacific Peripheral Artery Disease Consensus Statement Project Committee

Abola

Golledge

Miyata

et al. 2020

JAT

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Background: Peripheral artery disease (PAD) is the most underdiagnosed, underestimated and undertreated of the atherosclerotic vascular diseases despite its poor prognosis. There may be racial or contextual differences in the Asia-Pacific region as to epidemiology, availability of diagnostic and therapeutic modalities, and even patient treatment response. The Asian Pacific Society of Atherosclerosis and Vascular Diseases (APSAVD) thus coordinated the development of an Asia-Pacific Consensus Statement (APCS) on the Management of PAD. Objectives: The APSAVD aimed to accomplish the following: 1) determine the applicability of the 2016 AHA/ ACC guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease to the Asia-Pacific region; 2) review Asia-Pacific literature; and 3) increase the awareness of PAD. Methodology: A Steering Committee was organized to oversee development of the APCS, appoint a Technical Working Group (TWG) and Consensus Panel (CP). The TWG appraised the relevance of the 2016 AHA/ACC PAD Guideline and proposed recommendations which were reviewed by the CP using a modified Delphi technique. Results: A total of 91 recommendations were generated covering history and physical examination, diagnosis, and treatment of PAD-3 new recommendations, 31 adaptations and 57 adopted statements. This Asia-Pacific Consensus Statement on the Management of PAD constitutes the first for the Asia-Pacific Region. It is intended for use by health practitioners involved in preventing, diagnosing and treating patients with PAD and ultimately the patients and their families themselves.

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“…Finally, studies that did not include ≥10 punctures via the BTK arteries were excluded, leaving 19 articles for data abstraction. 5,12,14,15,19–33…”

Section: Resultsmentioning

confidence: 99%

Below-the-Knee Retrograde Access for Peripheral Interventions: A Systematic Review

et al. 2018

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A retrograde approach to facilitate peripheral endovascular interventions is a safe and successful technique and should be considered when an antegrade approach is not possible or fails to cross the lesion. Because of missing data on long-term outcomes and methodological shortcomings, real world data of retrograde access in nonexpert centers remains necessary before this technique can be advised to all interventionists dealing with peripheral artery disease.

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Endovascular retrograde recanalization in Asian critical limb ischaemia patients

Abstract: The subintimal arterial flossing with antegrade-retrograde intervention technique is safe with high technical success rates and acceptable outcomes in Asian CLI patients with CTOs.

Cited by 11 publications

References 11 publications

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

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

Asia-Pacific Consensus Statement on the Management of Peripheral Artery Disease: A Report from the Asian Pacific Society of Atherosclerosis and Vascular Disease Asia-Pacific Peripheral Artery Disease Consensus Statement Project Committee

Below-the-Knee Retrograde Access for Peripheral Interventions: A Systematic Review

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