Retrograde Proximal Anterior Tibial Artery Access for Treating Femoropopliteal Segment Occlusion: A Novel Approach

Endovascular treatment of femoro‐popliteal occlusions with retrograde tibial access after failure of the antegrade approach

“…Antegrade crossing of femoro‐popliteal occlusions may fail in about 20%–25% of cases, even in high volume centres with experienced operators and despite the development in endovascular technologies and the introduction of new tools in clinical practice such as re‐entry devices 5,9–11,31,32 . In cases of failure of the antegrade approach, crossing the lesion in a retrograde fashion represents a safe and effective alternative 9,12–15 . Retrograde crossing of occlusive femoro‐popliteal lesions is associated with a high (>90%) technical success rate and a low rate of procedural complications 33,34 …”

“…The failure rate can be up to 20% 11 . In cases of failure of the antegrade approach, crossing the lesion in a retrograde fashion represents a safe and effective alternative 9,12–15 . The distal end of a chronic total occlusion (CTO) is often tapered with a softer cap, resulting in easier penetration of the guidewire compared to the proximal cap 16 .…”

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

“…Eight studies reported on clinical improvement/symptom relief and/or wound healing during an average mean follow up of 8.0 months (SD 5.0). 17,24,30,32,34,36,38,40 Among 187 patients with available data, 129 patients experienced improvement of their symptomatic status (five studies; 81%; 95% CI 62%e96%) during follow up, 24,30,32,36,40 while 35 of 42 patients with available data, who presented with an ulcer at baseline, experienced wound healing (five studies; 95% CI 72%e96%). 17,32,34,38,40…”

“…Weight -% Zhuang 2020 14 Perry 2020 13 Lai 2019 16 Schmidt 2019 18 Palena 2018 19 Stern 2018 20 Matsumi 2017 23 Affonso 2016 24 Goltz 2016 25 Hanna 2016 26 Tay 2016 29 Walker 2016 30 Sabri 2015 31 Palena 2013 36 Ruzsa 2013 37 Yeh 2011 38 Spinosa 2005 40 Botti anterior tibial and the dorsalis pedis arteries. Distal arterial access and retrograde crossing was achieved in 96% of the cases, while procedural success was 91%, with only a few peri-procedural angiographic complications.…”

“…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.…”