Five-year retrograde transpopliteal angioplasty results compared with antegrade angioplasty

Evans, C.; Peter, Noel; Gibson, Matthew; Torrie, E.P.H.; Galland, R. B.; Magee, T.R.

doi:10.1308/003588410x12664192075099

Cited by 26 publications

(15 citation statements)

References 19 publications

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“…In the treatment of femoropopliteal lesions, the results of the antegrade and retrograde techniques are comparable, with no differences when considering freedom of target-lesion revascularization. 23 The popliteal approach was more often used for occlusions than for stenosis in these patients. Sangiorgi et al 24 report technical success rates of nearly 96% in long TASC C and D lesions and propose the transpopliteal access as a safe and effective alternative when antegrade recanalization attempts have failed.…”

Section: Discussionmentioning

confidence: 99%

Transpopliteal Balloon-Assisted Excimer–Laser Atherectomy for the Treatment of Chronic Femoropopliteal Occlusions: Feasibility and Initial Results

Lüdtke

Scheer

Kamusella

et al. 2014

Clin Med Insights Cardiol

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PURPOSERecanalization of chronic total occlusions (CTOs) of the femoropopliteal arteries depends on a successful lesion crossing with the guide wire. The aim of this retrospective study was to evaluate the safety, feasibility, and the primary results of retrograde recanalization of CTOs with balloon-assisted excimer–laser atherectomy (ELA) via a transpopliteal approach after failed antegrade attempts.METHODSA total number of 15 patients (10 male, 5 female) with a mean age of 68.5 years (range: 43–91 years) treated with retrograde transpopliteal ELA in the years 2009–2012 were included retrospectively. After unsuccessful antegrade recanalization attempts with conventional guide wires and catheters, patients were treated with a retrograde recanalization attempt via a transpopliteal access using an excimer laser, followed by pressure-only balloon angioplasty (POBA). The mean length of the CTOs in the femoropopliteal arteries was 17.8 ± 5.4 cm (range: 9–29 cm).RESULTSTechnically successful recanalization was achieved in 14 of 15 patients. Provisional stenting was done in two cases. There were no major adverse events regarding the laser atherectomy or popliteal access site. One acute reocclusion was observed in the first 48 hours after intervention. The ankle-brachial Index increased from preinterventional 0.45 ± 0.07 to 0.77 ± 0.29 (P < 0.05) in the follow-up period (1.5 months), resulting in a primary patency of 80%.CONCLUSIONThe retrograde ELA for recanalization of chronic femoropopliteal occlusions via a popliteal access turned out to be a safe and effective procedure with promising primary results. Thus it may be an endovascular treatment option for long chronic occlusions after failed antegrade recanalization or in patients who are not suitable for surgery.

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Section: Discussionmentioning

confidence: 99%

Transpopliteal Balloon-Assisted Excimer–Laser Atherectomy for the Treatment of Chronic Femoropopliteal Occlusions: Feasibility and Initial Results

Lüdtke

Scheer

Kamusella

et al. 2014

Clin Med Insights Cardiol

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“…In patients with chronic total occlusion (CTO) of the lower limb arteries and failure of antegrade ER, the retrograde access is a treatment option before referral for vascular surgery or conservative treatment. Several studies estimating long-term results of antegrade ER have been published so far, including those comparing antegrade and retrograde access sites [2, 3]. However, data on assessment of predictors of long-term outcomes of retrograde ER in patients with PAD are scarce.…”

Section: Introductionmentioning

confidence: 99%

Predictors of mortality and outcomes after retrograde endovascular angioplasty in patients with peripheral artery disease

Kleczyński

Ruzsa

Wojtasik-Bakalarz

et al. 2019

pwki

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Introduction Endovascular revascularization (ER) techniques in patients with peripheral artery disease (PAD) have been developed and became more accessible in recent years. The ER is a first-line treatment in the majority of patients with symptomatic PAD. However, data on assessment of predictors of long-term outcomes of retrograde ER in patients with PAD are scarce. Aim To evaluate predictors of long-term outcomes of retrograde ER in patients with chronic total occlusion in lower limb arteries. Material and methods We analyzed data of 834 patients who underwent retrograde ER. Baseline clinical characteristics and procedural data were collected. Patients were followed up for 36 months, and the primary endpoint was all-cause mortality. Results All patients were symptomatic and had failed antegrade ER. The procedural success rate was 92%. Cumulative all-cause mortality was 13.4% at 36-month follow-up. In multivariate analysis history of stroke, Rutherford category, chronic limb ischemia, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD) and previous ER of other lesion were independent predictors of a higher mortality rate after 36 months (hazard ratio (HR) for stroke 2.4, 95% confidence interval (CI): 1.55–3.66; p = 0.0002; HR for age per 10 years 1.37, 95% CI: 1.15–1.64; p = 0.0002; HR for Rutherford category 1.63, 95% CI: 1.35–1.98; p < 0.0001, HR for chronic limb ischemia 0.44, 95% CI: 0.25–0.8, p = 0.007; HR for CKD 1.73, 95% CI: 1.14–2.56, p = 0.01; HR for COPD 2.4, 95% CI: 1.5–3.7, p = 0.0004; HR for previous ER 0.59, 95% CI: 0.35–0.94, p = 0.02). Conclusions History of stroke, Rutherford category, chronic limb ischemia, CKD, COPD, and previous ER of other lesion were independently associated with increased risk of all-cause death.

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“…In the case of patients diagnosed with chronic total occlusion (CTO) of the lower limb arteries and failure of ER with antegrade access, retrograde access is a treatment option that can be offered prior to referring a patient to a vascular surgeon or possible optimal medical therapy. Several publications estimating long-term results of regular ER of PAD patients have been published [1,2]. The relationship between body mass index (BMI) and mortality rate in patients treated with percutaneous interventions has been widely investigated in patients with stable coronary artery disease (CAD), acute coronary syndromes and heart failure [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Body mass index and long-term outcomes in patients with chronic total occlusions undergoing retrograde endovascular revascularization of the infra-inguinal lower limb arteries

et al. 2021

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Background: The aim of the present study is to assess the relationship between body mass index (BMI) and long-term clinical outcomes in retrograde endovascular recanalization (ER) regarding chronic total occlusions (CTOs) of the infra-inguinal lower limb arteries. Methods: The study included patients who underwent retrograde ER of CTOs localized in superficial, popliteal or below-the-knee arteries. During follow-up, major adverse cardiac and cerebrovascular and major adverse lower limb events (MALE) were evaluated. MALE was defined as amputation, target lesion re-intervention, target vessel re-intervention and surgical treatment. Results: The study included 405 patients at the mean age of 67.2 ± 10.4. The authors divided the overall group of patients according to BMI into < 25 (n = 156, 38.5%) and ≥ 25 kg/m 2 (n = 249, 61.5%), and then into < 30 (n = 302, 75.8%) and ≥ 30 kg/m 2 (n = 103, 24.2%). During the average follow-up 1,144.9 ± 664.3 days, the mortality rate was higher in the group of patients with BMI < 25 kg/m 2 (10.5% vs. 5.3%, p = 0.051), and in the group of patients with BMI < 30 kg/m 2 (8.7% vs. 2.9%, p = 0.048). The comparison of Kaplan-Meier curves revealed borderline differences when assessing months to death for the BMI < 25 kg/m 2 (p = 0.057) and BMI < 30 kg/m 2 (p = 0.056) grouping variables. Conclusions: Obese and overweight patients undergoing CTO ER of the lower limb arteries from retrograde access are related to lower death rates during long-term follow-up.

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Five-year retrograde transpopliteal angioplasty results compared with antegrade angioplasty

Cited by 26 publications

References 19 publications

Transpopliteal Balloon-Assisted Excimer–Laser Atherectomy for the Treatment of Chronic Femoropopliteal Occlusions: Feasibility and Initial Results

Transpopliteal Balloon-Assisted Excimer–Laser Atherectomy for the Treatment of Chronic Femoropopliteal Occlusions: Feasibility and Initial Results

Predictors of mortality and outcomes after retrograde endovascular angioplasty in patients with peripheral artery disease

Body mass index and long-term outcomes in patients with chronic total occlusions undergoing retrograde endovascular revascularization of the infra-inguinal lower limb arteries

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