Outcomes at a single center after subintimal arterial flossing with antegrade-retrograde intervention for critical limb ischemia

Abstract

Retrograde pedal access is a viable revascularization technique for achieving limb salvage in patients with critical limb ischemia with acceptable patency for limb-threatening ischemia. This technique expands revascularization options after failed conventional endovascular antegrade approaches.

Technical Success and Complication Rates of Retrograde Arterial Access for Endovascular Therapy for Critical Limb Ischaemia: A Systematic Review and Meta-Analysis

“…The six month primary patency rate (<50% stenosis) was 78% (five studies; 95% CI 46%e99%) of 78 patients 17,19,20,22,38 the six month limb salvage rate was 77% (four studies; 95% CI 70%e84%) of 158 patients, 20,22,31,39 while major amputations were required in 20% (six studies; 95% CI 11%e32%) of 360 cases during a six month follow up. 14,17,20,25,31,35,39 Two studies enrolling 54 patients reported seven minor amputations (13%).…”

“…3,7,12,16e 21,23e28,30,32e34,36,38,41 Five studies including 631 patients reported a 6% (95% CI 1%e15%) 30 day major amputation rate 12,16,18,23,36 and five studies investigating 764 patients with CLI demonstrated a peri-operative (within 30 days from index procedure) all cause mortality rate of 2% (95% CI 0%e5%), with most deaths attributed to MI. 14,16,18,22,39 Peri-procedural outcome details are presented in Table S4.…”

“…Kwan 2020 12 Zhuang 2020 14 Htun 2019 15 Lai 2019 16 Raskin 2019 17 Schmidt 2019 18 Palena 2018 19 Stern 2018 20 Kaushal 2017 22 Matsumi 2017 23 Affonso 2016 24 Goltz 2016 25 Hanna 2016 26 Sabri 2015 31 Bazan 2014 32 Venkatachalam 2014 34 Palena 2013 36 Ruzsa 2013 37 Yeh 2011 38 Spinosa 2005 40 Botti of the CTO is usually softer (thinner cap; less calcification) and in some cases a cap is non-existent, enabling easier retrograde guidewire passage. 43,58 Additionally, when retrograde crossing is attempted, the likelihood of the guidewire entering into collateral vessels is lower, as collateral vessels are directed caudally.…”

Augmented reality navigation to assist retrograde peroneal access for the endovascular treatment of critical limb ischemia

“…Not surprisingly, retrograde tibial or pedal access is reported to have lower technical success and primary patency rates compared with antegrade femoral access 2, 4. In some complicated CLI cases, the technical success rate was reported to be as low as 63.5%, 5 and devastating complications have been reported 3, 6. In addition, there is a steep learning curve for tibial and pedal access, and the technique subjects the operator to more radiation exposure because of proximity to the radiation source 1, 7.…”

Open Proximal Endarterectomy with Retrograde Access and Stenting: A Novel Technique for Lower Extremity Revascularization

“…5,9 Several options have been described to address this issue, such as exploiting the subintimal space with subsequent re-entry into the true lumen. [10][11][12][13][14] In the following, we present the results from a hybrid modification of this approach. Open proximal exposure with retrograde access and stenting (OPERAS) concurrently improves inflow and provides a mechanism to directly visualize re-entry into the true lumen following retrograde subintimal crossing of a CTO.…”